There's nothing funny about feces

by Rich Heffern

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By Rose George
Published by Henry Holt and Company, $26

Rose George’s absorbing book is about the global reality and politics of human defecation.

Most of this book’s readers will be owners of or members of a community with ready access to a flush commode connected directly to a sewage-treatment plant. Some may even read pages while temporarily located on one of these handy, taken-for-granted devices.

The reality this book’s readers will come away with, though, is that billions in the world literally have no such place to go. It’s astounding to learn that most don’t even have outhouses, but just have to squat where they can. In the world, 2.6 billion people are without adequate sanitation.

Feces wind up all over the place, easily getting into food and water and causing misery. Inadequate sanitation causes 80 percent of the illness in the world and kills a child every 15 seconds.

The implications of this fact for the world’s public health are not funny at all.

The author has visited the sewers of huge cities like London, wandered the excrement-coated streets of slums in Asia and Africa, experimented with public toilets in rural China, and visited the workers who clean sewers or empty pits. There is a wealth of well-crafted explanation and description, some of it chilling to contemplate, including a ghastly description of what it’s like to die from cholera, a disease caused directly by poor sanitation.

For example: “Every day, 200,000 tons of human feces are deposited on India. I don’t mean that they are dealt with, or sent down sewers or given any treatment or containment. These 155,000 truckloads are left in the open to be trodden on, stepped over, lived among.”

If you don’t want to think about this problem, that’s just the problem.

There are 1.8 million child deaths each year related to clean water and sanitation deficiencies, dwarfing the casualties associated with violent conflict. “No act of terrorism generates economic devastation on the scale of the crisis in water and sanitation. Yet the issue barely registers on the international agenda,” according to a recent U.N. Human Development report.

Not all the news about human waste is bad.

The Chinese, George shows, are particularly innovative and open about sanitation. “Night soil” has always gone onto fields and rice paddies there. In recent years Chinese homes have been equipped with biogas digesters providing methane that heats homes and stoves. Urban areas in China face challenges, but the government knows how important appearances are. In preparation for the Olympics, holes in the ground were replaced with thousands of lavatories, complete with attendants.

Yet, in South Africa, kids stay away from school because the sanitation facilities are so inadequate. An official school lavatory might be something rigged up from a car chassis.

In the United States, we’re blessed with efficient waste removal and treatment, but big problems loom. The average American produces 77 pounds of excrement and 132 gallons of urine a year. Add toilet flushes and the total jumps to 4,000 gallons. As our population increases, that product begins to overwhelm our waste-disposal systems.

“The American Society of Civil Engineers grades the nation’s infrastructure every few years. In 2000, wastewater infrastructure got a D. By 2005, it was a D-minus. In 2000, the U.S. Environmental Protection Agency estimated that a quarter of the nation’s sewer pipes were in poor or very poor condition. By 2020, the proportion of crumbling dangerous sewer pipes will be 50 percent.”

George stresses again and again that it was innovations in sanitation infrastructure that made successful urban living possible.

A recent U.N.-Habitat report titled “The Challenge of Slums” defines a slum not by what it is, but by what it doesn’t have: secure housing tenure, good-quality housing and adequate access to water and sanitation.

Yet, George says, “it’s no use dismissing sanitation as a problem of the poor. It’s true that hardly anyone in the developed world dies from dirty water. But the diseases of the poor now travel thanks to international airlines.”

Last year, an outbreak of severe acute respiratory syndrome (SARS) began when an infected man in Hong Kong transmitted the disease to his brother because of a defective bathroom ventilator. It then spread on several international flights between China, Singapore and Canada. By the end of the four-month outbreak, 8,422 cases were reported; 11 died.

“The slums of Mumbai and Lagos may seem far removed from modern cities built on sturdy sewers and sanitary confidence. They look like a seething, desperate Dickensian past. But what if they’re thetfuture?”

Worldwide efforts are underway to do something about these problems. To meet the U.N.’s Millennium Development Goal for sanitation, 95,000 toilets must be installed every day. That’s a toilet a second, 24/7, until 2015.

Public-health engineer Pete Kolsky is optimistic about this project and detects a shift in the mindset of leaders and bureaucracies. “I don’t think it’s widespread among politicians yet but it’s getting there. They’re getting a clear and coherent message that, goddamn it, it’s time to talk about crap.”

Rich Heffern is an NCR staff writer. His e-mail is

National Catholic Reporter February 6, 2009

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