IPS News Agency: Fixing the 'Silent' Sanitation Crisis

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Fixing the ‘Silent’ Sanitation Crisis

By Isolda Agazzi

Nearly 2.5 billion people around the world don’t have access to sanitation. Credit: Charles Mpaka/IPS

GENEVA, Nov 18 2012 (IPS) - Organisers of this year’s World Toilet Day, which falls on Nov. 19, are using the slogan ‘I give a shit – do you?’ to break the silence around the crucial issue of sanitation and remind the international community that 2.5 billion people around the world don’t have access to clean and private toilets.

Improving these figures, and achieving the Millennium Development Goal (MDG) of halving the number of people without basic sanitation by 2015, needs a change of mindset and strong political will, not financial resources, campaigners say.

“(One and a half) billion people, or 15 percent of the world’s population, are still defecating in the open. Of the MDG targets for 2015, sanitation is the furthest off track… (At) the current rate it will only be reached in 2026,” Saskia Castelein, advocacy and communications officer at the Water Supply and Sanitation Collaborative Council (WSSCC) told IPS.

This Geneva-based organisation, created by a United Nations resolution, was responsible for making sanitation an MDG target at the 2002 Johannesburg Summit on Sustainable Development.

“In the last ten years, sanitation has made a lot of progress in terms of awareness and community approaches,” Castelein continued. An increasing number of “people and organisations are working around the issue and (are using) the MDG framework to lobby governments. Now there is more money, but challenges are still enormous.”

Jack Sim, founder of the World Toilet Organisation and initiator of World Toilet Day, is of the opinion that “What we don’t discuss, we can’t improve.”

Sim has been instrumental in putting the issue of sanitation on the international agenda.

“Over the last 12 years, World Toilet Day has become an amazing movement for everyone to support better toilets and sanitation conditions around the world. It has also become a day of creativity as people all over the globe celebrate it in their own style,” he added.

Much progress has been made in India, China and other parts of East Asia, with China being the most likely to meet the goal on time.

But most of Asia and sub-Saharan Africa are still riddled with problems, with only three countries – Botswana, Cape Verde and Angola – on track.

Various studies have shown that each dollar spent on sanitation brings a return of five dollars, yet the world has been slow to make progress because, according to Castelein, the issue is surrounded by taboos.

She argues that policymakers are reluctant to bring such an “unglamorous topic” into the limelight and governments are hesitant to interfere in this most private aspect of people’s lives.

Meanwhile cultural customs and habits are compounding the problem.

“In some places, it is a social tradition to defecate in the open,” a practice that often leads to the spread of diseases like cholera and typhoid, she said.

Diarrhoeal diseases, a direct consequence of poor sanitation, are the second most common cause of death among young children in developing countries, killing more than HIV/AIDS, malaria and measles combined, and resulting in one death every 20 seconds.

Thus, experts argue, improving sanitation in the developing would also expedite the fourth MDG – improving child health and reducing under-five mortality by two-thirds in the next three years.

Reluctance to embrace modern sanitation can be solved by “a community-driven approach,” Castelein said, with development practitioners going from village to village and “training the trainers” on the importance of proper sanitation.

According to Castelein, there is no need to invest millions of dollars into building water-flush toilets all over the world – all that is needed is a global effort to promote basic hygiene by educating people about simple steps like washing their hands with ash, which is a good disinfectant.

Many people, particularly in the developing world, are unaware that sanitation was proclaimed a basic human right by the U.N. general assembly in 2010. Increased awareness of this right could push people to pressure their governments to provide proper facilities.

Campaigners also point out that proper sanitation facilities are crucial for women and girls during menstruation; according to a study by Plan India, 23 percent of Indian girls drop out of school when they reach puberty. World Toilet Day demands safe and appropriate toilet facilities to keep them in school, thus overlapping with the MDG of eliminating gender disparities in primary and secondary education.

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“Earthquake” in Memphis

“Earthquake” in Memphis

The Medical Education & Research Institute (MERI) have developed a training program to ensure an effective interface between civilians and the military in case of a disaster.


At the University of Memphis (UM), Wright State University National Center for Medical Readiness (NCMR), and the Medical Education and Research Institute (MERI), they knew the odds of experiencing a hurricane is much less than “experiencing” an earthquake. It was with this thought in mind that they eveloped a training program to ensure an effective interface between civilian and military operations in the event of a catastrophe requiring aeromedical evacuation.

Many lessons were learnt from hurricane Katrina, including the need for a military agenda for crisis management and the need to implement multiple exercises to strengthen civil-military cooperation and communication. The surprising nature of natural disasters and their catastrophic effects call for massive coordinated responses on short notice.

The military has the manpower, equipment, training, and organization necessary to amass relief efforts required during catastrophic incident recovery.

Funded by a grant from the U.S. Department of Defense, the simulated earthquake scenario took place at the MERI with the sound of crashing furniture and falling ceilings, furniture was tossed about while the loss of electricity only served to amplify the sounds of “people” trapped under debris in the dimly lit building. Emergency sirens blared and suddenly there was the loud hum of military transport aircraft. Time was of the essence, and Memphis’ first responders and medical personnel prepared to maneuver themselves through the post-earthquake rubble.

All the simulators were used as the “walking wounded” in this “earthquake” exercise. Gaumard’s birthing simulator NOELLE® was in the throes of labor and hemorrhaging. Someone in this condition is not a candidate for military air evacuation because she isn’t stable. “Whenever you’re doing aeromedical evacuation, or leaving by air, you have to take into consideration the altitude changes. When you
have altitude changes, a small air leak in the thoracic cavity can become significant and cause increased pressure on the heart leading to cardiac arrest” noted Ms. Brown, Simulation Education Coordinator.

Such was the chaotic scene which signaled the start of the training for a mass-casualty drill. Continuing through to April, this course, Civilian Aeromedical Evacuation Sustainment Training (CAEST) brings together both


military and civilians interfacing in a very stressful situation, and under less than ideal conditions. It also encompasses the use of both air evacuation and transport.

“We were not only looking at how to deal with a disaster within our community, but how to work with colleagues, and communicating effectively with our military counterparts,” said Shirley Brown, MERI, Simulation Education Coordinator.

The MERI has been around since the 1990’s, starting as a non-for-profit bio skills cadaver lab where physicians could come and practice skills on un-embalmed cadavers. Their body donation program, Genesis, has evolved over the years to include a wider audience which now incorporates human patient simulation as part of the teaching methodology. First responders, physicians, nurses, respiratory therapists and EMS students have all come to the MERI, along with attendees from over 28 different countries.


MERI conducts concurrent sessions, one group in the anatomical lab doing high risk, low volume skill sets, such as needle compressions and another group working with the simulators where they will have to employ all those skills. “I think the biggest thing we’ve learned is that having cadavers and simulators under one roof has opened up a lot of unique training opportunities, because it really takes both modalities to cover all the bases,” says Brenda Belk.

MERI does not have a mobile RV, but they have taken 22 foot refrigerated trucks, loaded with anatomical donors, simulators and lab equipment all over the United States and Canada, recreating the lab environment in conference spaces, ballrooms, convention centers – wherever they are asked. This facilitates physicians who are unable to travel to Memphis.

“ I like that we can use your simulators with a patient monitor, the hospital can use their equipment, their supplies and things in their own environment and people really get to learn what to do in emergency situations, and they are familiar with where they need to go and who’s involved.”

One of the many things that the Civilian Aeromedical Evacuation Sustainment training (CAEST) prepares civilian nursing and allied health, public health, and emergency responders to do is appropriately assess and prepare patients in pre-hospital, harsh environments, and clinical collection sites for aeromedical evacuation.

Not all medical equipment is transportable. Careful attention to the types of equipment approved for air transport, along with ‘packaging’ the patient differently to compensate for fluid changes and swelling are also addressed in this exercise. This fact was brought out after hurricane Katrina, when some patients were unable to be transported, and there were those who felt that the military was simply not accepting patients. CAEST also serves to compliment already existing military training. There are significant differences between military and civilian systems, such as communications, medical triage, patient evacuation and transfer protocols which are all addressed in this course.

In 2011, five year old HAL® S3005 and Susie® S2000 participated in a real-life terrorist exercise where participants were trained to improve clinical outcomes and enhance patient safety. “We’ve had pediatric fellows use the baby and the five year old in high risk, low volume incidences,” said Shirley Brown, “such as seizures or cardiac arrhythmia, or conduct scenarios focusing on team dynamics and communication.”

Communication between civilians and the military is very different, but through these kinds of exercises, it has been found that if they both adhere to medical terminology, everybody is able to understand and ommunicate in a respectful, clear and concise manner. It is all about working as a team.

To learn more about the MERI please visit www.meri.org.