Since I arrived in Ethiopia in 1965, the population has increased significantly, from an estimated 20 million to over 100 million today. This remarkable growth can be attributed to improved healthcare services, better nutrition, and increased access to information among the public. The most significant contributing factor, however, is the widespread immunization of young children.
Despite these advancements, diarrheal diseases resulting from poor hygiene remain a leading cause of child sickness and death in Ethiopia. Consequently, the promotion of cleanliness is essential, and the installation and use of latrines can be a matter of life and death, particularly for the youngest and most vulnerable members of each community. The situation is particularly dire in remote villages with limited access to healthcare services.
The primary focus of this discussion is the impact of excrement on health, with a specific emphasis on human feces. While animal droppings are relevant as they attract disease-carrying insects like flies, it is worth mentioning that “traditional healers” sometimes recommend and use animal feces to treat open wounds. This practice is strongly condemned by medical professionals in modern clinics and hospitals due to the severe infections it can cause, often pushing patients to the brink of death.
In Ethiopia, there are challenges related to feces that extend beyond health concerns but are still significant for preventive efforts. Superstitious beliefs and cultural traditions hinder people from taking necessary precautions to prevent the spread of diseases. Although these beliefs lack a factual basis, they still impede efforts to combat the transmission of diseases.
While modern toilets have gained popularity in urban areas, many (if not most) Ethiopians, even those residing in cities, may still prefer to use a “Turkish toilet” rather than sit on a public toilet seat that has been used by many others. However, this preference tends to differ within private homes. The most significant challenge lies in rural areas, where the majority of Ethiopians reside. In these regions, it is still common practice to relieve oneself outdoors, typically in the evening or early morning, often in the darkness, and preferably in a secluded spot to avoid being seen by others.
In rural areas, it is common for women to carry water with them for their personal needs and engage in these activities in groups. This practice not only provides companionship but also offers a sense of security against potential attacks from men, prying eyes, and wandering animals.
Interestingly, women have even propagated the belief that men who spy on or inadvertently observe women during their toilet routines may suffer from night-blindness, a condition referred to as “dafint” in local parlance. Men, on the other hand, seem less concerned about being observed while urinating or defecating. In some instances men even urinate in full view of passers-by in urban areas, though they tend to avert their gaze when in the presence of colleagues (presumably due to the potential offense it may cause).
However, the pressing concern regarding toilet customs primarily pertains to defecation and appears to be more pronounced in rural settings.
The Ministry of Health, along with various voluntary and international organizations, has undertaken efforts to encourage behavioral changes in this regard. However, such endeavors can be viewed as a blunt interference in personal matters that have historically been regarded as private and beyond the purview of external involvement.
There also exists beliefs and traditions that act as deterrents to embracing modern innovations like the use of latrines. Some of these beliefs may stem from the fear of repeatedly using the same location due to a prevailing notion that these sites may harbor harmful magical substances, such as “denqara” and “tos,” which predominantly dissuade women from utilizing permanent locations for their evening routines. Women may also harbor concerns about other “magic medicines” that they fear may cause them to fall hopelessly in love with a man who has placed a certain love spell in an area they are expected to walk or step on.
Despite the concerted efforts made through mass media and improved education, these beliefs persist and continue to resist eradication.
In addition to combatting superstitions, there are other obstacles that must be addressed in order to achieve widespread adoption of latrines in rural Ethiopia. One such challenge is the attachment to old traditions. Ethiopia takes pride in its history of independence and rich cultural heritage, making it difficult to convince people to change customs that have been ingrained for centuries.
However, it is crucial to help people understand that certain traditions, customs, and habits can be harmful, despite their age-old existence, especially in light of advancements in knowledge and scientific discoveries. It may be necessary to emphasize that while traditions should be respected, there is also room for incorporating new practices that promote hygiene and prevent the spread of diseases.
One approach could be to build upon existing customs and traditions. For instance, it is nearly universal to wash hands before and after a meal, with cleanliness understood as a means to prevent contamination. This understanding can be extended to raise awareness about how diseases can also spread through contact with excreta. Additionally, there is a general sense of disgust at the thought of mixing one’s feces with that of another person, especially of the opposite sex, particularly when it involves strangers. This sentiment is rooted in attitudes rather than true knowledge or experience.
Overcoming such attitudes may prove challenging but is necessary to encourage the use of latrines, especially communal latrines shared by members of a village. Given that not every family in rural areas can afford private latrines, the initial focus may be on constructing communal latrines, perhaps one in small villages or settlements and multiple ones in larger communities.
In cases where it goes against the local sentiment for men and women to use the same latrine, separate latrines for each gender may be necessary. Some individuals, particularly women, may feel shy about others observing their bathroom activities. In such cases, it would be wise to construct latrines in secluded areas, such as near the edge of a forest. Many people prefer to have access to water for cleansing purposes after using the latrine. But, it is crucial to discourage locating latrines near water sources. Excreta from latrines can seep through the soil and contaminate the water, posing a risk to health if the water source is used for domestic purposes.
There is a common belief in Ethiopia that children’s feces are “harmless.” Similarly, the misconception that running water is always safe to drink and that animal droppings cannot contaminate water should be corrected through education and awareness campaigns.
People generally have an aversion to foul odors, especially emanating from unclean toilets. Additionally, there is a prevalent belief in many communities that bad smells can carry diseases. To address this concern, it is important to incorporate ventilation systems in latrines that help dissipate odors. Modern latrine constructions can effectively tackle this problem. Some communities also attribute the presence of evil spirits to dirty and malodorous places, associating them with disease transmission. Overcoming such superstitions can only be achieved through education and information campaigns. It is crucial to emphasize the importance of cleanliness in relation to latrines.
Efforts to make people realize that latrines can prevent disease rather than spread it require persuasive measures. It may be even more challenging to change attitudes to the extent that the possession and use of a latrine become symbols of progress and modernization rather than sources of fear and disgust. One potential solution could be the construction of latrines in all schools and official buildings, where students and public servants are instructed and encouraged to use the facilities. By integrating latrines into educational institutions, the next generation can become accustomed to their use. However, concerted efforts should also be made to encourage older generations to adopt latrine usage, which may prove to be a more difficult task.
What should be done when latrines reach their capacity? In Ethiopia, there is strong aversion and disgust towards using human and animal excreta as fertilizer. Some individuals believe that using excreta as fertilizer will lead to contamination of fruits or crops, and this notion deters people from consuming such products. Proper information dissemination is crucial to change these perceptions.
Over time, excreta become harmless, and full latrines must be left to undergo a period of several years to ensure their contents become safe. During this period, a new latrine should be built. After two to three years at most, the same latrine can be reused, provided that its contents are removed and preferably used as fertilizer in the surrounding fields.
The location of a latrine can pose a unique concern in certain cases, such as when a specific area is considered sacred by community members due to ancestral burials, worship of spirits, or the sanctity of water from a particular source (known as tsebel). To avoid disputes arising from such cultural beliefs, it is crucial to involve the entire community in the decision-making process before constructing latrines.
There are also numerous practical and technical factors that must be taken into account—or rather, should be considered.
The initial step before constructing latrines in a community is, in a way, political. For people to benefit from latrine construction, they must understand the advantages they offer. This requires education and motivation. Reluctantly accepted latrines may not be used, thus negating the health benefits for the community.
Sufficient time should be allocated to allow people to express both positive and negative views. Examples of successful implementations in other communities can be helpful, and the involvement of healthcare professionals is crucial. Positive experiences from neighboring communities, such as a reduction in disease incidents, can help sway those who are initially reluctant. However, if the health benefits are undeniable, some form of gentle persuasion may be applied.
Care must be taken, as those opposing latrine construction may also refuse to use communal or private latrines, thereby harming the community. Extensive and patient consultation is essential in any case. It may be advantageous to seek the support and cooperation of influential figures within the community to influence others positively. Persuasion is more effective than commands, and this requires organizational and practical efforts.
Community members who initially oppose the construction of communal latrines may be won over through indirect incentives. For instance, assigning them responsible tasks within a development committee or appointing them to supervisory positions can help change their perspective. Providing the community with a package of benefits such as improved water supply, fuel-efficient stoves, better health services, a plan for excreta disposal, drainage, vector control, and, if possible, financial support from local or central government authorities or aid organizations can serve as incentives with positive effects.
Regarding the technical aspects of the project, seeking professional assistance is vital. This includes carefully selecting the latrine’s placement, considering the aforementioned points. The quality of the soil where the latrine is built is important, as porous or soft soil should be avoided to prevent the collapse of latrine walls.
Proper ventilation and airing out the latrine are also essential. The latest designs of village latrines have incorporated vent pipes, leading to the creation of Ventilated Improved Pit (VIP) Latrines.
Significant efforts have been made to improve the health of the Ethiopian population, but much work remains to be done, particularly for the well-being of children and many adults. Numerous social, cultural, economic, and technical obstacles must be overcome before a sufficient number of latrines can be installed. Assistance provided to local communities has helped alleviate the situation for many, but there is still much progress to be made.
Reidulf Molvaer, is an author of several books on Ethiopia. He can be reached at: [email protected]
Contributed by ReidulfMolvaer