The malodorous indignity of open defecation in the 21st century

A young man is rushing to work early in the morning, thinking about the meeting he has to attend in less than an hour.

He makes his way through the meandering streets, jumping over dirty puddles and sidestepping heaps of garbage. He cranks up the music blaring through his ear phones and wills himself to walk faster. It will not do to be late.

He mentally goes through the notes for the meeting, rehearsing his arguments, buoying them up with more facts and figures. He can now spot the bus stop and next to it an impatient bus farting black clouds of diesel, raring to go, tugging at the leash that is the driver’s brakes.

He can hear the conductor calling out for just one more passenger. “Mmoja twende!”

He breaks into a run because he does not know how much longer he will have to wait if he misses that bus.

And that is when it happens. He is just a few feet from the bus when his right foot lands on something suspiciously squishy. A black swarm of fat flies roars up in consternation. His arms flail as he tries to catch his balance, struggling to remain on his feet. He looks down, and then the stench hits him.

Oh sh*t. Literally.

His right shoe is buried in a heap of fresh human excrement concealed cleverly in a black polythene bag. The young man watches in despair as the conductor shakes his head and ushers someone else into what would have been his seat in the bus. It roars away into the morning traffic, leaving him to deal with his unholy mess. His Monday has just gone to the dogs.

Does this sound a bit far-fetched or dramatic? Well, it is not. Not when you live in any of Nairobi’s sprawling slums where open defecation is a fact of life.

For the purposes of this story, our protagonist will remain faceless and nameless because he is just one of the many people living in slums whose experiences are peppered too often and too closely with other people’s faecal matter.

According to Mr George Kimathi, the programme Manager of the Wash, Sanitation and Hygiene Programme at AMREF, one in every ten people living in a slum in Nairobi does not have access to a toilet, so they are forced to do their business in paper bags, then fling the bags and their contents as far away from their houses as possible. This they do preferably under the cover of darkness when nobody can see or judge them.

“The situation in slums is very unique because it is more a failure in systems rather than the deliberate bullheadedness of the people,” he says.

How so?

EXPENSIVE AFFAIR

“Well, when you rent a house in a slum, it does not come with a toilet. Not like in other places. Toilets in the slum are communal structures shared out by as many as 1,000 people. And you need to pay Sh5 for the pleasure of visiting these toilets. So what happens when you do not have that 5 bob?” he poses.

And considering the socio-economic status of the people who live in slums, one can see how possible it is to sometimes completely lack the little money required to access a toilet. But that is not the only problem with ablution facilities in slums.

“You also have to remember that these toilets are shut at night. And even if they were open, some sections of the slums are so insecure that it is just not worth the risk to venture out of your house at night to go seek out a toilet that is about 100 metres away,” adds Kimathi.

All these factors considered, it is a minor miracle that the open defecation percentage in Nairobi’s informal settlements is not more than 10 per cent.

According to the Demographic and Health Survey of 2010, less than one-quarter of households in Kenya use an improved toilet facility that is not shared with other households.

The DHS survey goes on to say that “the most common type of toilet facility in rural areas is an open pit latrine or one without a slab (47 per cent of rural households), while in urban areas toilet facilities are mainly shared with other households (52 per cent). Overall, 12 per cent of households have no toilet facility at all; they are almost exclusively rural, accounting for 16 per cent of rural households.”

We are at Mukuru Hazina Slums in South B on a hot Saturday afternoon. Although the heat is oppressive and the shade inadequate, Mukuru is alive with activity and noise. Small children play games in the narrow streets, some chasing each other around, others pushing each other on bicycles in between the shanties, all of them shrieking with laughter, as carefree and happy as any children anywhere.

Even at play, they have mastered the art of avoiding the dirty rivulets and ditches that cut across the floor of the slum, deftly jumping over them without getting even the soles of their little plastic shoes wet. They also know better than to disturb the small heaps of ripening garbage that litter the streets lest they attract the wrath of a hawk-eyed parent.

The adults are conducting brisk business from their shanties, most of which double up as grocery stores or roadside food kiosks. Meat and pastries such as mandazis and samosas are a popular treat, with each street boasting several establishments selling one or both.

The sellers fight to keep swatting flies off their pastries, which are heaped in large metallic trays to attract customers. The meat, consisting mostly of offal and African sausage popularly known as mutura, roasts slowly on makeshift grills, a knife and chopping board on the ready to hack off a piece for buyers.

HUMAN CESSPOOL

At the end of a particularly busy street is a public toilet run by Kayaba Women Dancers, a group of 38 Akamba ladies who have managed the facility for close to six years now.

Kandita Nzilani is on cleaning duty at the facility. We find her busy scrubbing the toilets with a plastic brush and a basin of soapy water.

“Not less than 100 people visit this toilet in a day, so we have to work hard to keep it clean so that they keep coming back,” says Nzilani. She says they open the facility at 5am every day to allow city workers a chance to shower before they go to work. They lock up at 8.30pm.

“We charge Sh10 for a shower and Sh5 for using a toilet,” she says.

So far, she tells us, people are very good about the payments and using the toilets properly.

Her biggest concern is those who do not make it to the toilets before they close, forcing them to do their business in polythene bags in their houses then dispose of them in the streets.

Remember the story from the beginning? Well, other than the young man whose day was ruined when he stepped onto the smelly heap, Ms Nzilani is the second indirect victim of these unsavoury flying toilets. This is because it is her responsibility, as well as that of the other women in her group, to clean up any faecal matter left lying in the streets under their turf.

“We have to gather up the faeces along with any other rubbish and dispose it off at the river,” she explains. The river she is referring to is called Ngong’, a waterway that divides the slum into two. River Ngong’, which is one of Nairobi’s three main waterways — alongside Nairobi and Mathare rivers — is a fetid stinking mess that looks more like a sewage drainage system than a waterway.

It has a permanent putrid smell as a result of the residents using it as a dumping site. Most of the toilets, not only in Mukuru Hazina, but also in Sinai and Kibera slums, flush into this river. Throw in the industrial waste from the many firms in Industrial Area through which the river flows and you have a veritable biohazard on your hands.

Even in the midst of all this filth, Mr George Mbaabu, a resident at the slum for over 10 years, says things have tremendously improved at Mukuru Hazina Slum.

“I have to be one of the people who are most grateful for the existence of these toilets because before they were built, my morning duty every day was helping to push the excrement in the streets towards the river valley,” he says. “There was so much of it that walking the streets before we did the pushing was like wading through a human cesspool.”

Cosmas Mutiso, another resident, says that before the toilets came, walking the streets of Mukuru was a hazardous activity best left for the very brave.

“I have lived here for over 25 years. I have seen enough people get hit by paper bags full of excrement as they try to pick their way through the mess on the streets. You literally had to have one eye on the ground and another in the air to avoid either stepping on the stuff or being the unwitting victim of a flying missile,” he says with a chuckle.

Their graphic descriptions help bring the reality home for what life must be for slum dwellers with no access to proper sanitation facilities.

So, what does the hive of activity that is Mukuru Slums have in common with a sleepy village hidden in the vast grassland that is Kajiado County? The answer is a lack of toilets, proper sanitation and hygiene.

WIND OF CHANGE

In Orinie village of Kajiado Central, 308 out of 771 households have no access to latrines. They do their business in the bush, the only difference being that in Orinie, there is enough bush to go around that nobody ever has to see anybody else’s excrement.

But that does not mean open defecation in this county is any less of a problem than it is in Mukuru Hazina.

Sylvia Ronkiss, a 20-year-old mother of three, lives in the same homestead with her father, her mother, her step-mother and several siblings. The family has not dug out a latrine, so they all relieve themselves in the bushes near their manyatta.

“Most of the time it’s okay, because you can usually get a place that is far enough from the manyatta so nobody will see you,” she says. “But at night there is the risk of running into hyenas when you venture out to relieve yourself.”

What happens when you spot a hyena while on the prowl for a spot to relieve yourself?

“If that happens, you just have to go back to the house and hold it in until morning,” says Ronkiss with a small shrug.

She states this so nonchalantly and in such an unaffected way that indicates she thinks it is a stupid question to ask.

I ask her if she has ever had to “hold it” in until morning and she says yes, several times.

The reason for the general lack of toilets in Orinie cannot be lack of space as is the case in Mukuru. At Orinie, all you see is endless tracts of unused land.

Patrick Mainka, our guide and the project assistant in charge of Amref’s WASH programme in Orinie village, explains that the high level of open defecation in the area is due to the residents’ resistance to change.

“The people here want to hold on to their traditions and cultures. They have been going to the bush as far back as they can remember and are suspicious of anyone who tells them otherwise,” he says.

Sylvia confirms this by saying that while she has been to school and knows the importance of having a toilet, her father has dismissed her suggestion to construct a latrine for the family, saying that it is unnecessary.

But two kilometres from Sylvia’s home is another Maasai family which has broken with tradition and constructed a latrine and a bathroom.

This is Mzee Ole Mekure’s home that also boasts a house with a modern foundation, a dish rack and strategically placed tins of water for hand washing.

Ole Mekure’s decision to modernise was influenced by his first born daughter, whom he has educated up to Form Four.

“She came to me and told me that at school, they had been taught about the importance of having a latrine, how important it is for good hygiene and basic decency. She had a point. It was shameful for members of my family to have to seek out new places to hide in the bush whenever they wanted to answer a call of nature. So I agreed to build a latrine,” he tells us through a translator.

That was several years ago; Ole Mekure cannot remember how many exactly. Today, his home is used as a model to demonstrate to other Maasai families the importance of latrines, how to use construct them and how to use them.

According to the folk at AMREF, the latrine access in Orinie has improved from an appalling 15 per cent in 2012 to a more acceptable 60 per cent in 2015.

Poor sanitation and hygiene practices in Orinie have resulted in a surge of hospital visits where the records at the local clinic show that diarrhea is the third most treated disease in the area, closely followed by urinary tract infections.

This situation is mirrored in Mukuru Hazina, where Sheila Cherono, a nurse who runs the Lengo Medical Clinic in the slum, says she treats an average of 20 diarrhoea cases per week.

“Flagyl, a diarrhoea medicine for adults, is among the most sought out drug in this clinic,” she says.

This growing sanitation-related disease burden has a corresponding effect on the economic health of the country, with a newly released report by the United Nations Environment Programme saying that Kenya loses billions every year as a result of poor sanitation.

POOR SANITATION

“According to the 2014 Africa Water and Sanitation Report, more than 547 million Africans lack access to basic sanitation, a situation that, due to illness, premature deaths and school absenteeism, is costing the continent billions annually in lost Gross Domestic Product (GDP), including Sh31 billion in Kenya alone — or 0.9 per cent of GDP, according to the Economics of Sanitation Initiative,” states the UNEP report.

This is a rise of Sh4 billion as compared to the figures in 2012.

Last year, UN Special Rapporteur on the human right to safe drinking water and sanitation, Ms Catarina de Albuquerque, asked the Kenyan Parliament to pass a Water Bill that would improve people’s access to toilets, saying that a whopping 13 per cent of the population — which translates to around six million Kenyans — defecate in the open.

This Bill is still awaiting parliamentary debate, meaning that Kenya has no meaningful legislation to protect its people from the indignities that are associated with lack of basic sanitation facilities.

In acknowledgement of the dire nature of the situation, Health Cabinet Secretary James Macharia said at a past event that despite rigorous government and NGO efforts, “open defecation is still practised in Kenya” and that “in some counties open defecation remains the norm for more than 70 per cent of the population”.

He added that an ambitious 2013 campaign by the government to accomplish Open Defecation Free villages in Rural Kenya yielded less than 70 per cent success.

Currently, only two sub-counties in Kenya — Nambale in Busia County and Nyando in Kisumu County — have been certified by Amref as 100 per cent open defecation free. 

**********

Lest you forget 

The country is in the grip of a cholera outbreak in Migori, Nairobi and Homa Bay counties.

As of February 16, there were a total of 805 reported cases and 12 deaths. That number has certainly risen in the past few weeks. This is indicative of a country’s public health and sanitation that is on its knees.

The most obvious way forward would be to provide every Kenyan with a proper toilet and safe water for drinking and hand washing.

With these basics, we would be well on our way to saving lives, preventing diseases and realizing the billions lost through the current deplorable sanitation situation in the country.

_______________________

NO SHAME

In India, the smelly stuff hit the fan a long time ago

For all the obvious sanitation failures plaguing Kenya, they are no match for the situation in India. The Economist reports that out of the one billion people in the world who defecate in the open, 600 million live in India.

A survey conducted by the Research Institute for Compassionate Economics (RICE) found that in India “people have a very expensive idea of what constitutes a latrine, and do not build the kinds of simple latrines that save lives and reduce open defecation in other countries”.

Forty per cent of households that have a working latrine have at least one person who regularly defecates in the open, and less than half of people who own a government latrine use it regularly. Half of people who defecate in the open say that they do so because it is pleasurable, comfortable and convenient, the study found out.

India’s sanitation problem is exacerbated by a huge population and small pockets of liveable environments. Although the country is huge in terms of size, most of it is characterised by harsh deserts and the Himalayas, where life is impossible.

That means most of India’s 1.2 billion people are concentrated in small pockets of land mainly found in and around its biggest cities; Mumbai and Delhi.

SQUATTING IN DAYLIGHT

Mumbai alone has a population of about 12 million, most of which lives in shacks because the city’s regulations restrict putting up buildings more than ten stories high.

And with inadequate proper housing, shacks sprout up, bringing with them sanitation problems. These informal settlements are often built without a thought for a sewerage system, meaning that people are forced to do their business in the open.

Other than the obvious sanitation-related diseases that come with this sorry state of affairs, India’s open defecation has led to the chronic malnutrition of millions of its children.

According to the World Health Organisation, 50 per cent of malnutrition is associated with repeated diarrhea or intestinal worm infections from unsafe water or poor sanitation or hygiene.

Although India has made significant strides in economic growth and provision of food to its poor, malnutrition continues to plague many of its children under five years old.

An article published in the New York Times last year says that “these children live in districts with the highest concentration of people who defecate outdoors. As a result, they are exposed to a bacterial brew that often sickens them, leaving them unable to attain a healthy body weight no matter how much food they eat”.

Unlike in Kenya, where “squatting” in the open may take place usually under the cover of darkness, in India it is accepted and even embraced as a social norm borne of both tradition and a failed public sanitation system.

It has been found that sometimes even people with access to toilets choose not to use them in favour of defecating in the open.

This is why President Narendra Modi’s plan to build 5.2 million toilets by September last year might not work.

As the RICE survey notes, “simply building toilets and latrines does not change people’s minds about using them”.

“New policies must focus on creating demand for toilet and latrine use rather than building toilets that few people, other than the contractors who are paid to build them, actually want,” the report advises.