In which I fail utterly

Ethiopian macchiato: the gateway drug

As I stared into the half-full cup of creamy coffee, I could only think: I had failed.

Abysmally. Tragically. Pathetically. Just one more day to go, and I still had not succeeded at the task I had set myself back in March:

I was still horribly addicted to coffee.

India is primarily a tea-drinking country. You can get coffee there, of course, but you can’t get it on every street corner for 4 rupees (about 7 cents) like you can tea (chai). I’ve tried to decrease my consumption now for weeks, but I kept returning to it. I thought that when my flatmate moved out, taking the coffee maker, it would force me to switch to tea, but I would wake up in the morning to find myself halfway down the street to Starbucks. When I told the barista that I just wanted a plain, medium coffee, he laughed.

“My flatmate took the coffee machine!” I said.

“Oh no. That sucks. Room for cream?”

“Please.”

Now, the day before I leave India, I was at a diner called Java Jive with my third cup of coffee halfway empty in front of me, and the waitress asking if we wanted more.

“Yes,” the three of us chorus as we eagerly nudge our cups closer to her.

Screw it. I might as well enjoy the coffee now and be extra-miserable as I come off my caffeine addiction later. Maybe the misery of the caffeine let-down will be relatively indistinguishable from the misery of jet lag.

My companions are Sean and Anlam, the two other members of my department cohort. Tomorrow, I leave for India; in July, Anlam leaves for Germany; in August, Sean leaves for Malaysia. While I return in a few months, the others will be gone for a year or longer, finally setting off for their dissertation research. My research is just exploratory.

The conversation meanders comfortably over our fresh cups of coffee.

“We should probably clear the table,” Sean said, glancing around at the groups waiting for a table.

In the parking lot, we hug and promise to write.

“You’ve been an awesome flatmate,” I tell Anlam.

“You too.”

“It’s been a good place.”

“Yeah, in spite of everything.”

She laughs. “Yeah.” “Everything” includes the cockroaches, broken plumbing, obnoxious neighbors, poor climate control, and the incident with the shattering glass door knob. I’m fairly certain Anlam would add my propensity for playing Irish music loudly, the thump thump of in-room swing practice, and my clumsiness after I wake up early in the morning. (I don’t develop the ability to walk without hitting things until about 9 am.)

“Take care.”

“You too.”

Sean I’ll see tomorrow, and so our parting is brief. But I still feel a twinge of loss, the end of an era. I’m not good at good byes. I walk back to my car and go over the couple remaining things I have to take care of before I take off tomorrow—one more run to the storage unit, a quick run to school, another email…

But what I really want right now is another cup of coffee.

Questions I Imagine Someone Might Ask

You may be thinking, Oh my gosh! Flush the sanitation blog has returned! Finally, I can get my acerbically-written commentary and trivia about toilets and poop! My life is now complete! Or, potentially, you’re thinking, Hey, I was trying to get to a toilet fetish website, why the heck am I on this person’s blog?

In either case, dear readers, you will be disappointed. I am not returning to blogging on sanitation in the way I did before. Sanitation will be a part of it, because it’s what I study, but I am using this as a platform for a personal blog, so interested people can keep track of where I am, what I’m doing, and why I’m doing it. (Hi mom!) It’s a bit like a mass e-mail, but longer and less personal. Some of it is also a self-indulgent writing exercise to keep my writing brain limber and to remind myself how to write for normal people. (“No, ‘hegemony’ and ‘panopticon’ are not normal words, Jen.”)

So, after that unnecessarily long introduction, let me tell you where I am, what I’m doing, and why I’m doing it.

At this moment, I am sitting on a beanbag in my apartment at a desk I constructed out of two cardboard boxes, a yoga mat, and the inside shelves on a bookshelf that I demolished yesterday. I am still in Atlanta for a short time yet—I would count the exact days on a calendar, except I am afraid it will cause me to scream and start packing at midnight or frantically scanning books. I leave June 2^nd—I leave the math up to you. In the meantime, I am slowly selling, packing, and getting rid of the bits and pieces that have made up my life in this particular abode.

I have lived in this place for the longest I have lived anywhere since I moved out of home for college, and as I look up at the now-blank walls, I cannot help but wistfully sigh. But there is plenty to loathe about this place too; just this day, I gently steered a man who was inquiring our leasing office away from renting a property. (“You do not want to live here. Cockroaches, termites, ants, and the shower I had in rural Ethiopia was better. Seriously. Just don’t.”)

Since people don’t ask me very many questions, I don’t really have frequently asked questions. So I’ll just write Questions I Imagine Someone Might Ask.

QIISMA

Q: Where are you going?

A: India.

Q: Unlike many Americans, I have a slightly more nuanced knowledge of that subcontinent’s geography/I know how to use basic map resources and care enough to do so. Where in India?

A: I fly into Hyderabad to visit some dear friends from when I studied abroad. From there, I will take a train to Delhi, and then from Delhi, I will take a train to Bhubaneshwar.

Q: Wait, why are you doing this?

A: I just finished my third year at Emory. I spent two years in the anthropology department, working on my doctoral program in anthropology, then one year getting my masters in public health. Now, I am finally done with coursework and I can enter the stage of my doctorate where I can do my research. This summer is the exploratory bit for that. I am going to network and assess the feasibility of doing my dissertation in the two different field sites I’m considering.

Q: You mean you aren’t done with school yet?

A: No. I’ve got a while. Leave me alone.

Q: So what are you doing while you’re there?

A: Lots of talking, exploring, looking around. I am interested in the politics and economics of sanitation, so I’ll be talking with representatives from NGOs and the government who work on sanitation issues, trying to get a baseline read on what’s going on there. Why is the sanitation situation so bad? How bad is it? How is it measured? Who is trying to improve it? What has been tried before? What is being tried now? What are the justifications for these approaches?

This is sort of a basic, bastardized summary of what I’m doing, but it’ll serve.

So, I hope, imaginary someones, I have answered the questions you might have. If you have any more questions, feel free to ask. I’ll be updating this sporadically.

Back to packing!

The last post

Hello all!

This is my last post. I’ve been blogging about shit and shitting for just over a year, and while there is plenty left to blog about, I need to re-focus on other endeavors.  

But I think it's still important to carry on the conversation. We need to be able to talk shit, because shit is a part of our lives. We need to be sensitive to the subject, but not tip toe around it. There is too much suffering and too much damage that has come from not talking about the issues around shit. So I hope as you consider your lives--as you go into a poorly made restroom, as you flush your toilet, as you donate to a campaign abroad, as you watch a video about sanitation abroad--you're a little more aware and a little more thoughtful. If I've helped with that at all, I will feel supremely accomplished. 

Thank you so much for those who’ve read, those who’ve shared, those who’ve commented, and those who have sent me links! I've really appreciated all your support--and have appreciated only some of your jokes. :)

Well, I guess it's time to finish.

**FLUSH!**

Pee-powered phone

No, it doesn't charge when you drop it in the toilet, but scientists at University of West England have designed a cell that works on urine. Check it out:

Urine, is fairly non-pathogenic (but don't drink it) and can be used for fertilizer, composting, and now, powering batteries. Honestly--this is so cool.

(Incidentally, I think the two of us have the same phone.) 

Rainbow urinals remind men to wash their hands

A couple of people sent me this recent NPR post on new urinal design that has a handwashing sink built right in so that (1) it saves water and (2) it reminds men to wash their hands.

Source

I’m a big fan of both things. Toilet-sinks have been around for a while. (Check out instructions how to make one yourself here.) They’re a marvelous use of water; the fact that we flush anywhere from three to six liters of water every time we flush, then go and (hopefully) wash our hands racks up huge amounts of water wastage. A single person may flush 6,400-12,800 gallons of fresh water per year.

Exactly.

As far as an in-your-face reminder to wash your hands, god knows we need it. Scientists who’ve studied this know it too. One 2003 study by Johnson and colleagues looked at public restroom handwashing rates at a Pennsylvania State University.

Results? Out of 175 individuals (95 women and 80 men), 61% of the women washed their hands (with soap) and 37% of the men. (The latter percentage increases to 53% of men who just rinsed their hands without soap.) When they put up a sign to remind people to wash their hands, 97% of women washed their hands and 35% of men did. (55% of men just rinsed.)

Disregarding strange mental images of how this study were conducted (I may need to do a post just on strange observational handwashing studies), the numbers are abysmally low. So if this urinal helps increase that number, all power to them. While as I’ve pointed out previously, urine is relatively safe, that bathroom you’ve entered is basically covered with fecal matter. And unless you’re randomly scrubbing during the day, your time in the bathroom is going to be the only times during the day that you’ll wash your hands of all the junk you’ve picked up from everywhere.

So 65% of men at Penn State?

Wash your hands. Or do we need to buy you rainbow urinals?

Love,

Everyone 

Ends and means, rape and sanitation: setting priorities

 **Potential trigger warning. 

Public health is a wonderful field full of motivated and energetic people with a real drive to do good in the world. There is ostensibly something elegantly uncontroversial about many of the goals of global health: you’re preventing people from dying from preventable or curable diseases. You’re saving lives. While other programs are sticky with politics and controversy, health programs keep people alive, and that is good.

            This is the kind of narrative that has attracted many people (myself included) to the field of public health. In this whole mess of a world, we can at least we can do this—get children a headstart in life by encouraging their mothers to breastfeed, give people clean water, immunize people against diseases. But this kind of thinking has resulted in a tendency to have a end-oriented perspective: the ends justify the means. Preventing children from dying is important and good, and this is an end that justifies its methods.

            This is the sort of thinking that led to some of the brutalities of the smallpox vaccine campaign: lies and manipulations of government officials, doors kicked down in the middle of the night, children held down and forcibly vaccinated. The harsh memories from those days lingers on in these places, and it hinders current vaccination work and collaboration. Yes, we eliminated smallpox, and that is incredible—but what was the cost?

            Community-Led Total Sanitation (CLTS), as I’ve previously blogged, is an approach started by Kumal Kar in Bangladesh. It triggers disgust in a community at open defecation, then and mobilizes community shame in order to motivate individuals to build their own latrines. This approach is ubiquitous around the world, but most particularly in South Asia. Amina Mahbub, an anthropologically-trained health practitioner and researcher, wrote a chapter in the book Shit Matters: the potential of community-led total sanitation. Mahbub’s chapter discusses how CLTS approaches affect women and children in Bangladeshi communities. While she points out that CLTS does not do a good job helping the extremely poor, her review is a mostly positive perspective of the approach.

            I’m not going to go into a line-by-line critique of the whole chapter or discuss the approach overall (I’ve done the latter previously), but this sentence just stopped me short:

“VDC (local government) members…further stated that no bichar (arbitration) would be held if young women and adolescent girls were raped whilst defecating outside” (47).

Let me repeat that: If someone is raped while trying to find a place to defecate, the village counsel is going to ignore it. They are going to ignore rape. Because a young women or girl, who is looking for a place to defecate outside because she probably can’t afford a toilet in her house, deserves to be raped.

Source

I believe in sanitation. I believe in its importance to change lives for the better and its importance in ensuring health. But I do not think there is any justification for measures that rely on the degradation of women. These are older, powerful, male villagers who said this. They are seated in places of privilege. With the government and NGOs looking at them to decrease open defecation, they are strongly motivated to decrease OD in order to maintain or increase their prestige. When they say they will not arbitrate rape cases, they are telling young women that their bodies, their rights, do not matter as much as their status. They are telling men that it's open season on any young woman you see after dark, because you can always say they were out defecating.

The next sentence is, “Therefore the extreme poor were compelled to install toilets.” How sad, really. Instead of wanting to install toilets, instead of being worked with to improve their sanitation situation, they are threatened—the threat of the awfulness of rape or by the loss of honor that would come with having a female in the household raped.

Most approaches—this one included—are multipronged, so it’s difficult to point out what particular aspect of any approach was effective. So I cannot argue with this approach on an effectiveness level; we cannot say, Well, at least it’s effective or This wasn’t even effective.

But effectiveness isn’t the point. While yes, open defecation put the whole community at risk, does that really excuse these kinds of threats against individuals? Furthermore, what do you think people will remember next time a development group wants their cooperation?

The struggle for better health for all (which is really what we’re in this for) is a long, long struggle. Impatience leads to collateral damage. ‘Ends justifies the means’ behavior leads to other problems in other areas down the line. In trying to save people, let’s not make their lives worse.

Surprise! People don't always make healthy choices

Rodan Gatia fetches water in Kenya. A chlorine dispenser is behind her.
NPR

NPR’s Planet Money recently published a story on the widespread issue of poor water quality entitled, “A surprising barrier to clean water: human nature.” They tell the story of  how they thought that clean water was an engineering problem. Give people wells, then it’s all good, right? No, not quite. Water was getting contaminated somewhere in the house; the containers were dirty, or water was contaminated during storage (ie, small children playing). So, how about making chlorine tablets available? People aren't buying them. What if we give them for free? In a dispensary right next to the well. They’ll do it then, right?

Still no—still lots of contamination. People didn't like the taste of the chlorine additives, or they just don’t bother with it.

My favorite part of the story is the following:

GREEN-LOWE (employee of CARE implementing clean water in Kenya): I've had malaria five times now. I have a bed net hanging above my bed and I don't use it.

REPORTER: Why don't you do it?

GREEN-LOWE: It's 45 seconds. It's a burden. I don't want to. I either don't think about it or feel stubborn.

The story closes out with the following observation: “People everywhere - in rural Kenya, in New York, wherever - we just don't always do all the things we're supposed to do.”

So—sorry—

Why is that a surprise?

People don’t do what’s good for them, even if it requires a relatively small amount of effort. While we more readily acknowledge this problem in the US, in international work, people seem continually surprised.

Unfortunately, it’s part of the double standard that we so often attribute to people in other countries. We think that their poverty and foreignness renders them more susceptible or open to suggestions by outsiders.

While yes, the article is on water, we can definitely see some of this double standard tendency with some of the worst sanitation programs around. In the US, I've seen people go behind a bush rather than use a latrine because it smelled bad. Maybe a person can spend their scant income on a new toilet, but their daughter is getting married, and a wedding is more important to them. People are pragmatic, and they have to prioritize; this happens everywhere.

 We should not be surprised when people reject interventions that make their lives more complicated or difficult when the only benefit is an abstract health one. It doesn't work in the US, and it doesn't work abroad. This should not be a surprise to anybody at this point—and yet, it keeps surprising people.