by Rose George
On the face of it, Gram Vikas was arriving with a gift horse. They were offering to contribute to building a toilet and bathroom for each family. They would also provide 24-hour running water by digging bore wells or channeling nearby springs, and they would build a tower to store the water in. But they were also asking for money. Under the Gram Vikas model, each family had to contribute 1,000 rupees ($25) to a common fund. Gram Vikas would contribute the big costs—cement, doors, latrine pans—and the fund would pay for the rest and then for upkeep and repairs. Families who couldn’t afford to pay cash could pay with labor or in kind. Still, when the daily wage was less than a dollar a day, Gram Vikas was asking for the moon.
The persuaders had to craft their message carefully. There was little point telling villagers they were risking their health, because health messages rarely have an impact. I call this the “doctors who smoke” theory. Doctors know the harm smoking does, but they smoke. Reason rarely persuades people to change behavior. Research in Benin into why people want a latrine found that their principal reasons were to avoid embarrassment when visitors came; to make the house complete; not to have the chore of walking to get water; and to feel royal. Improved health never came into it. Dr. Val Curtis of the London School of Hygiene calls hectoring health messages the “doctors, disease, and diarrhea” approach. It never works, and it’s not culturally relative. When Curtis did covert surveillance of hand-washing rates in her own institute, she found that male students—who are, let’s remember, students at the London School of Hygiene, and well schooled in disease transmission—failed to wash their hands after the toilet in 60 percent of cases. Only when the surveillance was announced by email did hand-washing rates leap 80 to 90 percent. Curtis likes to refer to the success of soap manufacturers, who got soap into nearly every household in the early twentieth century not by promoting its health benefits but by telling consumers it would make them smell better, be more attractive, be sexier. Soap companies understood that they should target their product to wants, not needs.
In Samiapalli, Gram Vikas had to create a want by bribing people with a need. They focused on women. They were the ones who fetched water from the pumps. In Samiapalli the pumps weren’t far, but water is heavy. Gram Vikas told them they could have a tap in their kitchen if they’d build a latrine and bathing room, too. The bathing room was on Joe’s insistence, because his catchphrase is “building dignity through toilets.” He’d seen enough women trying to wash themselves under their saris at the bathing ponds, and how that brought scabies and vaginal infections by the score. Villagers had to agree to build the latrine and bathing rooms up to roof level, and then Gram Vikas would bring water. Sojan Thomas, the Gram Vikas sanitation director, smiling under his moustache, calls this “a by-force business.”
It took 162 meetings, and two years of talking. Gram Vikas appealed to their prejudices. Sojan gives an example. “Often richer people say, ‘Poor people don’t need toilets, they’re dirty people. Let’s carry on the program without them.’ And we say to them, ‘These people are still shitting by the pond. A fly that has touched their shit is not going to distinguish between Brahmin and Dalit food. If you have toilets and they don’t, that means that your food is definitely being contaminated by lower-class shit.’ We appeal to their ego and it usually works.”
After the latrine-building project was complete, people realized that their toilets were better than their houses. So they applied for housing loans, with Gram Vikas as a guarantor, and now they have concrete pukka houses that don’t blow away in a cyclone. (When anthropologists complain that Gram Vikas is not preserving “authentic” thatched roof houses, Joe suggests they try living in an authentic thatched house in a monsoon.) Women got enough confidence to start speaking in meetings, then to tie wife-beating husbands to lampposts, then to set up self-help groups. With the time saved from fetching water, they can sow fields of peanuts or cultivate fish. Children’s attendance rates at school have shot up, because they are sick less often and because there are fewer chores to do around the house. Before toilets, 10 percent of girls went to school. Now it’s 80 percent. But the biggest thing they have got now, the village leader tells me with a big smile, is pride. “We are better than higher-caste places! People from higher-caste villages want to come and live here!”
A toilet for Gram Vikas is never only a toilet. Joe calls sanitation “the entry point.” It’s the most difficult entry point and the one that people are least likely to agree on, but once they do, anything is possible. A toilet can change society in unexpected ways. For example, it can improve your marriage prospects.
At Bahalpur, we arrive unannounced. A woman runs up to give me a bunch of flowers, nonetheless, and a meeting is swiftly convened on a veranda. I have learned by now to recognize a Gram Vikas village. From afar, by the yellow water tower; and from nearby by the Gram Vikas slogans and posters painted on the walls. Common to all the villages I visit is a poster that shows a middle-aged woman in the foreground, and in the background a young woman entering a clean-looking latrine. Translated from Oriya, Orissa’s state language, it reads: “I will give my daughter in marriage only to a village with a toilet and a bathroom.” I’d taken this as the propaganda it looked like, but in Bahalpur I changed my mind.
On the veranda, men with towels draped on their shoulders sit on one side and women on the other. But the women are unveiled and they are chatty. They crack jokes. Joe is astonished, because he hasn’t seen this before, and because in the beginning, the women wouldn’t even come to meetings. I ask the women whether the poster is true. “Oh yes, our girls don’t want to marry into families from Malad and Borda, because they don’t have toilets.” In fact, a girl has just left her toiletless in-laws to return to the village, and she arrived home the day before. The girl, whose name is Gilli, is fetched to be questioned, and sits at the back of the group, her eyes cast down. She looks mortified. She’s not supposed to speak to strangers, because she has been married less than a year and has no children. But the women give dispensation, and Gilli says, “It was very difficult. The drinking water there is from the pond. They shit on one side and take their bath on the other.” She’s trying now to pressure her parents to persuade her husband’s family to build a toilet, but they may also send her back, toiletless. The conversation moves on, and shortly afterward I see Gilli halfway up the hill, walking away as fast as possible.
But girls have to be married, so the villagers are trying to persuade their neighbors to sign up for the Gram Vikas project. This is sanitation contagion. The more villages that join, the easier it gets. Now, any village that is interested can send representatives to stay in a Gram Vikas village to experience a toileted lifestyle. It is one-way traffic. “We do go to other villages,” a towel-wearing man says, “but it’s very hard for us now to visit villages where they defecate in the open. We stay for dinner but we’ll always come back.” When relatives come to stay, they are told to use the latrine or else.
Or else what? Villagers have learned about compliance because they had to. In the early days of the project, with the latrines built and the water supplied, people were still going for open defecation. They were too used to “going out there in the open with the wind in their sails,” in Joe’s words.
The village council already had the practice of fining people who transgressed village rules in some way. It was easy to set up a new system of open defecation fines. Defecating in the open would cost 51 rupees (one rupee is added to the round number for auspiciousness). The person reporting the offender kept half the fine. The rest went to a village fund. Joe likes to say that the toilet can build livelihoods. With this fining system, a new livelihood of Toilet Spy came into being. Some people gave up their day laboring because reporting people was more lucrative. The women giggle about it now. “For the first three months people continued to go outside. But we could spy on them because they always carried an aluminum vessel of water. Then after they were caught they would still try to sneak outside and hide
a bottle under their arm.” The repeat offenders were caught, too, until open defecation was finally banished. No one would dream of doing it now.
Some might find such a system too coercive. Perhaps it pits villagers against each other. Perhaps it’s not democratic enough. It’s all relative—in Sierra Leone, one NGO suggested bringing in the army to get people to use latrines. Anyway, fines were already imposed for transgressions. In fact, all that has happened is that morals have entered the toilet room. There is now a right and a wrong defecation behavior, and toilet habits have become a communal concern. Sanitation projects often falter, says the sanitation specialist Pete Kolsky, because of a mentality that considers that “my crap is your problem.” In Gram Vikas villages, everyone has acknowledged that it’s everyone’s problem. This is a very big deal.
The Gram Vikas method is effective, but it is slow. Today 361 villages have 100 percent sanitation, but there are 50,000 villages in Orissa. At present rates it would take Gram Vikas centuries to reach them all. This is the burning question for sanitation experts. There are good projects everywhere, but how can they be spread? In development language, how can they go “to scale”? Kolsky talks about “the false question. You look at a jewel of a development project and say, why can’t we multiply this by a thousand? Because you can’t. You’ve got to have something that can be done by Joe Shmoe or an ordinary bureaucracy.” Joe Madiath admits that his two great problems are finding human beings who want to live in villages for the two or three years that projects usually take, and finding funds. “Ours is a difficult model,” he says. “I always face an inquisition from the government because we insist on one hundred percent compliance. They say it’s too much. They are content to say that whoever wants can have a toilet and never mind the rest.” But he’s stubborn. “We believe that if it can be done in Orissa, in the poorest state in India, it can be done anywhere in the world.”
The Gram Vikas model provides subsidy because Joe believes in quality. Technology for the poor, he says, should not be poor technology. But in the years that Gram Vikas has been sweating away in Orissa, a conceptual shift has taken place in government and in sanitation thinking. Subsidies, an essential of India’s latrine-building program, have fallen from favor.
India’s efforts to eradicate open defecation are directed from New Delhi by the Rajiv Gandhi National Drinking Water Mission, part of the Rural Development Ministry. Its offices are on the eleventh floor of a tower building whose lifts only stop at even-numbered floors. I go to the twelfth, assuming I can walk down, but this floor houses the Indian Air Force’s Adventure Corps, as is revealed by several photographs on the walls of dashing Indian men with black moustaches and Himalayan backdrops, and by a locked steel gate blocking the stairway. Presumably it’s more adventurous if in an emergency the air force officers leave by the window.
I arrive at the office of Sanjay Kumar Rakesh, director of the RGNDWM (an initialism that is actually used) late and in a fluster, and it’s an appropriate start, because in twenty minutes Rakesh answers half a dozen phone calls and two emails, and deals twice with his assistant, all the while failing to introduce or explain the silent man sitting next to me. In between, he finds time to tell me that things have changed radically. The CRSP is dead; a new program called the Total Sanitation Campaign (TSC) has risen in its stead. The TSC has things in common with the Gram Vikas model. It still dispenses subsidies, though less than before. Now, only poor families can get one, and only $11, a third of the old subsidy. But a more important change was to recognize the power of persuasion, as demonsrated in a remarkable regional sanitation program in the Bengali district of Midnapur. Its Intensive Sanitation Campaign, carried out by the local Ramakrishna Mission and UNICEF, abolished the subsidy-heavy model of the CRSP in favor of education and persuasion. The software was backed up by hardware, easily available in a network of Rural Sanitary Marts, local shops selling sanitary equipment at reasonable prices. It was a big success, and helped to inspire a change in policy. Before, the success of sanitation programs had been judged by compiling statistics about coverage. In short, counting toilets. The Intensive Sanitation Campaign and other similar projects throughout India tried a new approach. They counted, instead, how many people were still going for open defecation. A new acronym—ODF, for Open Defecation–Free—was created to sum up the new goal.
The TSC also aims to achieve an ODF India, though Rakesh is still counting toilets. He rattles out some figures. Coverage is increasing by 7.5 percent a year. Extensive monitoring. I ask to see a monitoring report and he tells me to check the Web site. (I do, and the links don’t work.) I ask about the Millennium Development Goals and he shrugs. “We’re not concerned with those. We have already met them. We have to reach 55 percent coverage by 2015 and we’re already at 45 percent.” He seems bored. He says, “Everything is on our Web site. Is there anything else?”
It is a frustrating interview, but it shouldn’t detract from the fact that the TSC is an improvement, or that Rakesh’s boss, Rural Development Minister Raghuvansh Prasad Singh, has said that “a toilet or the lack of it is the indicator of a country’s health, not the GDP or Sensex [the Bombay stock exchange].” And he has put money behind this conviction. The TSC is lavishly funded. With a budget of $810 million, it is twenty times bigger than Bangladesh’s sanitation budget, though the number of India’s toiletless is only ten times that of Bangladesh’s. The minister has creativity as well as cash. In 2003, the Nirmal Gram Puruskar (Clean Village) prize was launched, awarded to villages judged to have 100 percent toilet coverage, 100 percent school toilet coverage, and to be open defecation–free. In the prize’s first year there were 35 winners out of 70 entrants. The following year there were 770 entrants and in 2007, ten thousand villages applied.
The awards are handed out by the president of India and get serious media coverage. Other efforts by Minister Singh have been more controversial, such as a letter he wrote in 2005 to all chief ministers demanding that they pass a law requiring anyone running for local office to possess a latrine. No toilet, no election.
TSC still had problems. Not all regional officials wanted to abandon subsidies, because doling out subsidies makes politicians popular with voters. So some states have diverted funds to keep their subsidy levels high, with predictable consequences. Researchers found half the latrines unused in some TSC project areas. Something was still not working. Meanwhile, over the border in Bangladesh, something was.
On a day in 1999, an Indian agricultural scientist called Kamal Kar arrived in the Bangladeshi village of Mosmoil. He was there as a consultant for WaterAid, which had asked him to assess whether the organization’s subsidy approach and latrine-building program was working. WaterAid couldn’t understand why its Bangladeshi branch had been building latrines for years, but 40 percent of the country’s illnesses were still the excrement-related kind. Kar thought WaterAid was asking the wrong question. “Let’s not talk about subsidy,” he told his employers. “Let’s find out instead why people are shitting in the bush.”
I meet Kar in his spacious apartment in Salt Lake City, an affluent suburb of Kolkata. He has an intense energy, which shows through a ceaseless jiggling of his legs and speech at the speed of a machine gun. He is blunt. “You can’t be a doctor and be scared of blood, and you can’t work in sanitation and be scared of shit. Anyway, no one understands you when you say sanitation.”
At Mosmoil, Kar used techniques from a discipline known as “participatory rural appraisal.” (A layperson may ignorantly translate this as “asking people you’re trying to help what they think.”) This usually involves a walk through the village—“a transect walk”—and asking locals to draw a map of their surroundings. Kar did this, but the transect walk, once it had passed through the nice parts of the villages, carried on to the areas used for open defecation. On the map, once the houses had been chalked in, villagers were asked to indicate where they usually went to defecate. As Kar explained in a how-to guide to the method, “It is imp
ortant to stop in the areas of open defecation and spend quite a bit of time there asking questions and making other calculations while inhaling the unpleasant smell and taking in the unpleasant sight of large-scale open defecation. If people try to move you on, insist on staying there despite their embarrassment. Experiencing the disgusting sight and smell in this new way, accompanied by a visitor to the community, is a key factor which triggers mobilization.”
The calculations involved villagers doing their sums. They were asked to reckon how much excrement was being left in the open. “The accumulated volume of feces,” Kar wrote, “is reckoned in units that can immediately be visualized by the community—cart loads, truck loads, boat loads. There is much amusement as people reckon which family contributed the most shit to the pile that morning. But as the exercise goes on, the amusement turns to anxiety. People are horrified by the sheer quantity of excrement left in their village: ‘120,000 tons of shit is being dumped here every year? Where the hell does it all go?’”
The answer, as the villagers of Mosmoil figured out for themselves, is “into their bathing ponds and rivers; and from there onto their clothes, their plates and cups, their hands and mouths. Onto the udders of their cows and into their milk. Onto the feet and hooves of their livestock, dogs, and chickens, and onto the flies that carry it straight to their food.” Eventually, the villagers calculated that they were eating 10 grams of each other’s fecal matter a day. At this point, the brilliant core of Kar’s method is revealed. The brilliant core is disgust.
Disgust is probably the least studied of all human emotions. It has been called “the forgotten emotion of psychiatry.” Opinions still vary as to its composition, function, and genesis. William Ian Miller, in Anatomy of Disgust, one of the few serious books on the topic, sets out the two main theories. Biologists, he says, think disgust is innate. What is disgusting is usually what is bad for you. This was given credence by a huge online poll carried out by Dr. Val Curtis. Participants were asked to choose one of two similar pictures. In all cases, the picture judged to be more disgusting—the greeny-brown soup over the blue gloop; the worms, not the caterpillars—showed something that could carry disease. Greeny-brown looks like body fluids, which can be dangerous. People have worm burdens, not caterpillar burdens. Humans experience disgust, Curtis theorizes, because it keeps them alive. Anyone who doesn’t find excrement disgusting risks contracting diarrheal diseases from getting too close to it. “If you’ve got an innate capability to avoid things that are going to eat you from the outside,” she tells me, “then probably you’ve got an innate ability to avoid things that can eat you from inside. Parasites are bad for you because they make you sick and die and you won’t reproduce. Also they make you unattractive and you won’t reproduce.” But our disgust is also visceral. When volunteers were blasted with skatole, the smelliest compound in feces, none could stand it for more than five minutes, and all expressed physical signs of disgust such as facial expressions and pallor. This needn’t trouble Curtis’s theory: What is more visceral than the need to survive? Another study found that when presented with a selection of dirty, unlabeled diapers (one of which belonged to their own child) mothers regularly ranked their own babies’ feces as less disgusting than others. Parenting, desirable for the survival of the species, would be compromised if mothers were distracted by disgust.