Happy holidays from Flush!

Did you know Google image searching "Christmas toilet" is fun? (And weird?)



 

 

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I hope you all have a wonderful holiday season! I'll be off blogging until the new year, so stay tuned then!

Is public urination a problem?

On a relatively quiet street corner, deep in the depths of the old part of the Indian city of Hyderabad, I pass a high wall, painted with, “URINATION PROHIBITED.”

 

I frown. I was used to seeing gentlemen standing on the sides of roads or up against walls in the tell-tale wide-legged stance. But this wall was different. There weren’t even the dark red betel stains (a dark red chewing tobacco popular in the country) on the wall. “What do you think that’s about?” I ask my companion.

“It’s a graveyard,” she says.

That made sense. Indian Muslims traditionally bury their dead, so their bodies may rise up later. Of course you would not want such a sacred place being defiled by urine.

Defiled—interesting choice of words, says I to myself. Why is urine defiling? To many of us, public urination is disgusting. According to Rozin and colleagues’ CAD moral emotions hypothesis, offenses against the community breed contempt, offenses against individual autonomy breeds anger, and offenses against ‘divinity’ (purity, sanctity) breed disgust. Public urination, then, is a very literally an offense against divinity in the case of the graveyard wall.

Many people have very strong reactions to public urination. In India, a man was allegedly killed over the fact that he was urinating at a gas station. Another article asks why this is such a problem in India, and cites a lack of “civic sense” or a lack of public urinals as the cause.

This is bemoaned as an issue in Western countries as well. In the US, you can be cited as a sex offender for urinating in public or receive huge fines, in spite of the fact that for many people, there are literally no other places to go. (Think taxi cab drivers in New York—presuming you could find a restroom and that someone would let you use it in a Starbucks or such, where would you park?) Anxieties about public urination in late hours has resulted in urinals in the UK that rise up out of the ground in the late hours in order to accommodate drunk men.

I’m going to stop here and point out that anxieties about public urination are entirely focused around men. Women have been long conditioned to hold it for long hours rather than drop trousers and squat in public spaces. There is also a significantly different amount of bodily exposure involved in the two processes—guys just unzip and go, women have to actually expose their entire genital area.

Let’s just flip this question though—not so much why do people urinate publicly, but why do people have a problem with it?

First off, the smell is not pleasant—whether this is a biological predilection or more of the association of, ‘ewwww someone peed here, that’s weird’, I’m not going to try to argue right now. Second, there are those who argue that the acid damages statues and cement. Third, it can leave stains which recall that someone pissed in public (and dark stains are not necessarily very pretty).

As far as the act itself, people are not comfortable with men’s genitalia being in public places. In great part, in the US, this is closely related with our deep discomfort with our bodies—as animalistic and natural, as ‘dirty’ (ie, getting rid of fluids and waste), and as sexual. (On the human body, the parts of our body involved in sex and the parts involved in elimination are close together, creating a deep discomfort with both processes and their relations to each other.)

But I’m going to point out that none of these are health issues. They are, for the most part, aesthetic issues, caught up in our ideas of where urination can take place and what parts of the body can be exposed where and who can expose them. (Body exposure is notoriously culturally contingent—shoulders, for example, are scandalous in India, whereas stomachs, not so much. Here, more or less the opposite.) Urine is actually quite benign, disease-wise. There are almost no diseases that can be transmitted via urine.

So when we see a rise in concern with public urination in other places, we have to ask, what shifted? What changed about aesthetics or body beliefs or disgust or what-have-you? Because public urination isn’t a health hazard, for the most part. So why do we have a problem with it, and why is it emerging as a problem in other places? What can this tell us about the spread of Western cultural values and anxieties?
 
This all said and done, I am going to add that if a drunk guy pisses on my lawn on a Friday night, that doesn’t mean I’m going to shrug it off as culturally relative.

I have the grass to think about, after all.

"Are Indians by nature unhygienic?"

Sign in India advocating against open defecation
Author photo

A few weeks ago, B.S. Raghavan wrote an article that appeared in The Hindu, one of India’s largest newspapers. The title was immediately controversial: “Are Indians by nature unhygienic?” In the article, he writes of the litter and of the “general lack of cleanliness and hygiene” in both public and private spaces. He writes that, “Indians think nothing of spitting whenever they like and wherever they choose, and living in surroundings which they themselves make unliveable by their dirty habits” and that “If one wants to keep one’s sanity, one should avoid entering the kitchen of a hotel or even an ordinary household. I sometimes wonder how we are still alive eating at our hotels.” He finishes with the extra-controversial, “Are Indians then, by nature oblivious to standards of hygiene? And among Indians, are Hindus more indifferent in these respects than others?”

He’s not alone. Earlier this year Soutik Biswas, BBC Delhi correspondent, wrote an article entitled “Is India’s lack of toilets a cultural problem?”  In this article, he writes, “Is the lack of toilets and preference for open defecation a cultural issue in a society where the habit actually perpetuates social oppression, as proved by the reduced but continued existence of low caste human scavengers and sweepers?” It seems it is, he says. He cites that even in his upper-class Delhi suburb, he’ll watch his neighbors take their dogs out on the lawn to shit—as long as the shit is not in their house, it is ok if it is in a public space.

            India does have a severe sanitation issue. Over half of India’s 1.2 billion people have no toilet at home—if you look at the rural areas, that ratio goes up to 2/3. No one will contest this. Neither will anyone contest that India has hygiene, sanitation, and litter disposal management issues. However, these articles definitely make some statements that should be contested.

 

Trash piling up on the sides of Husein Sagar in Hyderabad

            Raghavan wrote that Indians are, by nature, unhygienic. By nature? As soon as you invoke “nature,” you threaten to biologize the issue, that somehow written in Indian DNA is a tendency to be “unhygienic.” This slippery slope is especially troubling when you consider that the writer is an Indian living in a pretty nice suburb of Delhi. The fact that he is writing in English states that he is pretty well educated. All in all, Mr. Raghavan is in a position where he undoubtedly has the financial resources to have a toilet at home, running water, and trash bins. When viewed through this perspective, his argument about “Indians” being “naturally unhygienic” becomes a sort of biologizing of  perceived negative aspects of being lower class.  

            Furthermore, what exactly is cleanliness? As a friend and colleague points out, “When one says that India is dirty etc, what is the standard one is judging it by? If it is ‘western practices’, then there is no way India could measure up, because these are themselves changing all the time.” In particular, I found it interesting the way in which different practices and senses were collapsed into one damning category: public urination, public spitting, haphazard disposal of litter, not sanitizing lunchboxes, open defecation and dish rags in kitchens. Why are all of these practices conflated? It is not disease that is the common thread in all of them—urine is relatively benign as a fluid. Then it is the aesthetic concern that seems to bind all of these practices together, and that aesthetic concern may indeed be Western.

            Biswas, on the other hand, blames Indian culture for the perpetuation of human scavengers (who clean up shit manually). While there are certainly aspects one could label “cultural” (however you want to define that term) that have caused the perpetuation of that practice (the caste system, strong fecal taboos, ideas of purity and pollution, etc.), the scavenger class was not really codified until colonial rule needed someone to clean up the city once the Yamuna had dried up, rendering the sewage system that had been built in Mughal times inoperable. Socioeconomic factors are one of the primary means by which caste is perpetuated.

            Both of these writers target Indianness or Indian culture as somehow being the reason that there are such sanitation problems. They both pay a sort of lip service to social and economic factors, but their acknowledgement of this is limited solely to the acknowledgement that the government has not done a stellar job of building toilets. Calling a lack of sanitation or hygiene a cultural problem or saying that Indians are somehow “naturally” unsanitary is problematic and troubling. By calling something “natural” or “cultural” it conceals social, political and economic factors that contribute to unequal standards across the world.

Rainbow urine? Urine analysis in medicine over the centuries

17th century print of a physician analyzing a patient's urine
Source

Urine is the way that we get waste products in our bodies, out of it. Generally, we're quite happy to flush it away, except for those unpleasant times when we have to maneuver in such a way as to pee in one of the dreaded sample cups. As an EMT, one of the bad things we’re told to watch out for is“coffee grounds” in the urine (indicative of internal bleeding). Dark urine is indicative of dehydration. Other things to watch out for are things like really sweet-smelling urine, which is indicative of diabetes. Most of the analysis work in clinics and hospitals is done by electronic sensor arrays, a complex set of electronic equipment that can breaks down the chemical composition of the urine. Yet urine analysis was around long before there were complex technologies to do it.

Of traditional Asian medicines, urine analysis is a diagnostic tool that is relatively unique to Tibetan medicine. Chinese medicine did not pick it up until later, and Indian Ayurvedic medicine only uses it when diagnosing urinary diseases. One of the oldest extant Tibetan texts, The Lunar King, describes in great detail how to analyze urine by observation, to analyze the connections between urine, disease, and evil spirits, and how to engage in “urine divination.” The text is quite extensive, detailing analysis down to when and where the urine should be analyzed (at first rays of light, indoors), the container it should be analyzed in (no color), and the patient’s responsibilities before the urine sample is taken (moderate drinking, no sex, no white, yellow, or red drinks, no strong-tasting foods).

Once these conditions are set up, the color of the urine is examined. A few of the possible diagnoses are:

                        -Red indicates excessive blood

-Reddish-yellow indicates excessive lymphatic fluid

-Dark red indicates infectious disease from excessive blood

-Very yellow indicates bile

-Brown or bluish yellow is from phlegm

                        -Black indicates lymph and wind

                        -Green indicates cold.

                        -Brightness (“rainbow colors”) is cold and poison

The analysis also includes looking at smell, sediments, and whether the urine divides into layers over time. Urine analysis continues to be one of the primary markers of Traditional Tibetan Medicine.

While the Tibetans were analyzing urine on one side of the planet, the Greeks, the Arabians, and the Byzantines were also very interested in urine as a diagnostic tool, looking at much the same things that the Tibetans were: color, smell, sediment.

Urine analysis continued in western medicine as well for centuries. The following graphic is from the book Epiphanie Meidcorum by Ullrich Pinder, published in 1506. This graphic helps instruct physicians how to diagnose diseases from the varying colors of the urine. Like in Tibetan medicine, health in the western world was viewed as being a balance between different Humors. In Tibetan medicine, there are three: in Western medical systems, there are four. Abnormally colored urine indicates that the humors are out of balance--too much blood, perhaps, or too little lymph.

 

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I actually have no idea what might cause dark green urine, but I have the feeling, if you see that in the toilet, you should probably go to a hospital.

World Toilet Day! (And play true/false with Matt Damon!)

Happy World Toilet Day, everyone!

Here is the "about" from the World Toilet Day website:

This international day of action aims to break the taboo around toilets and draw attention to the global sanitation challenge.

Can you imagine not having a toilet? Can you imagine not having privacy when you need to relieve yourself? Although unthinkable for those living in wealthy parts of the world, this is a harsh reality for many - in fact, one in three people on this globe, does not have access to a toilet! Have you ever thought about the true meaning of dignity?

World Toilet Day was created to pose exactly these kind of questions and to raise global awareness of the daily struggle for proper sanitation that a staggering 2.5 billion people face. World Toilet Day brings together different groups, such as media, the private sector, development organisations and civil society in a global movement to advocate for safe toilets. Since its inception in 2001, World Toilet Day has become an important platform to demand action from governments and to reach out to wider audiences by showing that toilets can be fun and sexy as well as vital to life. For more information and tools to share: http://www.worldtoiletday.org/whatis.php

WTD's campaign focuses on the theme "Who gives a shit?" and features adorable kids like this one holding signs. (Check out more or post your own on their facebook page!)

Another promotional website is Toilet Day.org which encourages people to "Talk Sh*t for a Day!" You can join their feed on facebook or twitter, and they'll post toilet-related factoids to your feed all week!

Plus, watch and play this video with Matt Damon on sanitation facts. (Kudos to Matt Damon for being a spokesperson for sanitation!)

YEAH Matt Damon!

Facts from the campaigns:

*1 gram of shit can contain 10 million viruses, 1 million bacteria, 1 thousand parasites, and 100 worm eggs
*More people have a mobile phone than a toilet
*Shit diseases are responsible for more than 50% of the 9 million preventable child deaths each year
*More people die of diarrheal diseases than HIV, malaria, and TB combined
*The estimated gain in economic productivity if everyone had a toilet is $225 BILLION dollars.
*40% of the planet doesn't have a safe place to defecate.
*1.5 million children under 5 die every year from diarrhea.

So share with your friends, post on facebook, talk about it: sanitation is one of the world's greatest health problems, and we need to talk about it to get it done. Let's talk about it fearlessly, seriously, and let's aim for sustainable action.

We can do this.

Why they removed the "shit" from my shit article

Hey all! I just found out I got an article published in the Society for Applied Anthropology Newsletter on sanitation: "The Stinky Revolution: how a horrible stench changed the course of urbanization." It draws on one of my favorite historical events that I also talk about in this blog post and this one--the Great Stink in London in 1857 that served as the catalyst for London's sanitation system.

Unfortunately, the editors decided to change all my uses of "shit" to "feces"--I find this interesting. It was a lengthy back and forth with the student editor about it, and I defended (quite strongly) using "shit." "Shit" is used in social science contexts because, quite frankly, there aren't very many good synonyms for it. Rose George in her book The Big Necessity is the one who converted me to using "shit" instead of the easier, more gentle synonyms.

Let's go over them, shall we?

Feces: this is a medical, clinical term, that doesn't really speak to lived realities of shit. (When you have a river of it, you don't think of it as feces--you think of shit.)

Dookie, caca, poop, number 2: Childish. We're uncomfortable with the act, so we render call it by childish things (because children are allowed to defecate; adults can't talk about it) or use a euphemism.

Waste: Ambiguous. Shit is waste, and so is poor spending by the government.

This is why I use "shit" in non-medical contexts. It's not that I particularly enjoy swearing or shocking people (although whether the word itself should be shocking is up for debate). It's because it's the best alternative in most situations.

Online Etymology dictionary writes of its origins:

O.E. scitan, from P.Gmc. *skit-, from PIE *skheid- "split, divide, separate." Related to shed (v.) on the notion of "separation" from the body (cf. L. excrementum, from excernere "to separate"). It is thus a cousin to science and conscience. Despite what you read in an e-mail, "shit" is not an acronym. The notion that it is a recent word may be because the word was taboo from c.1600 and rarely appeared in print (neither Shakespeare nor the KJV has it), and even in "vulgar" publications of the late 18c. it is disguised by dashes. It drew the wrath of censors as late as 1922 ("Ulysses" and "The Enormous Room"), scandalized magazine subscribers in 1957 (a Hemingway story in "Atlantic Monthly") and was omitted from some dictionaries as recently as 1970 ("Webster's New World"). Extensive slang usage; verb meaning "to lie, to tease" is from 1934; that of "to disrespect" is from 1903. Shat is a humorous past tense form, not etymological, first recorded 18c. Shite, now a jocular or slightly euphemistic variant, formerly a dialectal variant, reflects the vowel in the Old English verb (cf. Ger. scheissen).

It's origin--that of being from the Latin for to separate--is benign. So I'm a bit frustrated that they decided not to stick with "shit"--especially considering this newsletter is for anthropologists, who really shouldn't be shocked anymore--but I do understand it. Unfortunately, most of English's curse words relate to either religion or the body (or bodily acts).

"Shit," though, because it carries so much weight rhetorically, is uncomfortable to use in many contexts. I'm reserved about using it in my daily life--I don't use it when generally discussing my research to most people (such as my boyfriend's mother) in a casual context and in the twenty minutes of an undergrad lecture I did on disease ecology where I spoke about diarrhea, I stuck with "feces" the whole time. (People were already uncomfortable talking about the topic.)

So you can check out my sanitized article in the newsletter above. Hopefully, when I write my dissertation, I get to choose the synonym I use.

Guest bloggers wanted!

Hi everyone!

I'm so excited to say that Flush has reached over 1000 page views! Thank you all so much for reading, posting, linking, and sending me things!

I'd like to expand the blog by inviting others to contribute. Any blog post on any topic related to shit, toilets, sanitation, disgust, the body, or whatever you think is relevant. Lengths and styles are flexible. A post can be a photo essay, a reflection on a news article, a video, your musings on a particular topic from a unique point of view, an excerpt a post on your favorite (or least favorite) toilet in your area...Everything is on the table! You will, of course, get full credit.

Please contact me at j a b a r r [at] emory . edu if you would like to participate!

Thanks so much all!

Toilet theme park and other mini posts/links

When multiple people send me something, I have to include it. (Thanks Howie and Holly!)
South Korea recently opened a theme park/museum in memory of a past mayor, who was so concerned with good public toilets that he built his house to look like one. The park includes a bunch of statues that show people defecating in various postures, including (I think my favorite) The Thinker.

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Also included in this week's list of links is a podcast from Freakonomics, in which they discuss how the French tried to take care of the rats in the sewer problems in the French quarter in Vietnam, and how they utterly failed. (It's several minutes in to the podcast.) The French attempted to kill off the rats by placing a bounty on rats. However, this made people bring in rats from the outside to collect the bounty. This sort of fear of rats coming through the toilet, incidentally, seems to speak to our fear of things coming up the down hole in the toilet. (Think of those python in the potty urban legends.)

Here's a short but interesting article on a village in India who is trying to use public shame--including drums and whistles--to stop public urination. It includes this interesting quote:
"Officials say cultural and traditional factors, a lack of education and too few toilets are the prime reasons why millions of Indians defecate in the open."
Too few toilets--very true. 1.2 million people do not have toilets in their homes in India. But "cultural and traditional factors"? I may not object to their blaming "culture" (whatever that is) if they at least went into a little bit of detail about what they mean. Unfortunately, "culture" is often used in this sort of short-hand way to obviate responsibility for poor infrastructure. Because in many cases, can you really say it's a "cultural thing" when people don't want to use latrines because they're smelly? I remember going into a public restroom in San Diego by the sea shore where there were no doors on the stalls, because I didn't feel comfortable being that exposed. This is very easily a "cultural thing" (body shame in American culture), but how often would people call it that?
Secondly, it would be interesting to examine who is shaming whom. How do other power structures--like class and caste--play into this use of shame? This is very much an example of the sort of thing that Community-Led Total Sanitation advocates--community shame used to create public health change. But is it effective in the long run, and is it ethical?

Sit or squat?

Hello everyone! It's been a while since I've posted, but I've been slammed with school. I'm so amazed, though, at how popular this blog has gotten! Thank you all who've read or shared!
As a side note, I am asking for guest posts! I would love any post on any sanitation-relevant topic. Go ahead and send your submission or pitch to me at jen [dot] anne [dot] barr [at] gmail [dot] com.

Back to the post!

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The sitting toilet that those of us in the West have come to know has been around for centuries. The ancient Romans would sit on the toilet. And the design makes an intuitive sense, right? If you want to be comfortable, you sit in a chair. (Ostensibly, anyway. I hate chairs). You want to be comfortable while defecating, right? So sit in a chair.

But millions of people--in the Middle East, parts of Europe, and Asia--squat. Some people squat because they don't have a facility and thus are forced to go in a field or a water source, but millions of others choose to squat, with toilets that are especially designed for it. A growing movement in the US is advocating for replacing our standard chair toilets with squat toilets in the interests of health.

So which is better?

Daniel Lametti of Slate wrote an excellent article in 2010 on the squat vs. sit debate. He explains the how defecation works:
"People can control their defecation, to some extent, by contracting or releasing the anal sphincter. But that muscle can't maintain continence on its own. The body also relies on a bend between the rectum—where feces builds up—and the anus—where feces comes out. When we're standing up, the extent of this bend, called the anorectal angle, is about 90 degrees, which puts upward pressure on the rectum and keeps feces inside. In a squatting posture, the bend straightens out, like a kink ringed out of a garden hose, and defecation becomes easier."

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In his excellent 1966 book, The Bathroom, Alexander Kira, an architect, recommends the squatting position. A variety of people--from the healthy living types to actual medical doctors--have recommended squatting as a matter of health, claiming you get more complete defecations that flush more toxins from the body or that it prevents colon cancers. As with most cancer claims, it hasn't been fully substantiated (cancer is far too complex in many cases, to associate with just one thing), but squatting has been shown to prevent hemorrhoids. It also simply takes less time. Lametti got his 10 minute routine down to a minute by squatting on the edge of the toilet. (The perching sounds terrifyingly precarious, to me.)

However, just because our "ancestors" did it, doesn't necessarily make it better. The human body is a pretty buggy thing. Selective pressures only act on a population if it affects reproduction somehow. Most of the health problems that people argue that squatting will prevent don't occur until post-reproduction--in other words, after the individual has probably already passed on their genes.

Knees are another good thing to consider. What would be the ease for the elderly? Our knees are not particularly well-designed--bipedalism did a number on us--so how would our knees hold up as get older for such a deep squat to a high rise? Actually, not as badly as you might think, if people did it for their whole lives. We would develop the muscles.

In India, the trains would often give you the option of a "Western toilet" or a squat toilet. "Western" toilets are becoming more popular amongst the middle class in India, perhaps as a status marker and a sign of "modernization." Squatting--since it is what our ancestors do--often can carry the stigma of primitiveness with it. It reminds us far too much of the very animal nature of defecation or it is seen as a "cultural practice." ("Culture" in far too many discussions, is used as sort of a trump card of backwardness.) Chairs, on the other hand, are supposedly very "civilized," and by sitting we coat our most 'primitive' activity with a veneer of civility. Also by sitting, we really can't see what is going on while we defecate, increasing our distance from the act. It may be our body doing it, but we don't want anything to do with it.

Personally, whenever I could, I much preferred the squat toilets. Why? While the chances of catching a disease from a toilet seat are relatively rare, there is the mental discomfort from the idea of knowing that a very private part of my body is touching the same thing that other people's bodies have touched. Toilet seats feel unclean, even if microbially it may not always hold true. Plus, in Indian trains, because of the movement of the train, it is very possible to miss, and so the fixtures often don't look very appealing. Squat toilets do not have any direct body-fixture contact. You just are suspended above the bowl--no need for wiping the seat or seat covers.

Various entrepreneurs have sought to bring the squat toilet to here the in the US, either through an addition to the regular toilet that allows you to use it like a squat one or a completely different fixture. My favorite is a toilet that converts, allowing one to choose what style of defecation one chooses to use. (Watch the video if you're confused.)

However, people are generally very resistant to any change in this most intimate part of our lives, especially in Western cultures. Changes are seen as a bizarre deviation or a joke. (Just think of all the jokes about Japanese 'supertoilets.') Squatting is what our ancestors did, but because of that, we have a great resistance to it.

What are your thoughts? Sit or squat?

Happy global handwashing day!

October 15th is Global Handwashing Day. (Check out the link.)

Handwashing is one of the most important hygiene steps that can be done to prevent fecal-oral transmission of diseases. Global Handwashing Day is to help promote this practice around the world.

Check out the CDC webpage on handwashing and handwashing promotional materials.

Mayo Clinic has some do's and don'ts of handwashing.

And enjoy this animation, winner of the 2009 Golden Poo Award--it's pretty adorable.

 

Code Red! An app for that time of the month and adjusting to patriarchy in the public toilet

"Desperately seeking a tampon? There's an app for that," reads the headline on CommonHealth, the Boston NPR affiliate's health blog.

As the article says of the Harvard students who came up with this idea, "They came up with a simple prototype: a mobile app that would allow women in need to send out a “red alert” that would ping other nearby users who could rush over and delivery a tampon or sanitary pad or share information on where the nearest working tampon vending machine might be."

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Menstrual waste management is one of the most taboo subjects in public health--even more than shit and sanitation. While there is an increased acknowledgement of the need for toilets, there has been no increase in discussions on menstrual waste management. Since it's all interconnected, I have no compunctions about addressing it on this blog.

Poor menstrual management can lead to infections, toxic shock syndrome, discomfort, and a series of social embarrassment. Discussions about menstruation in American society are silenced: men don't want to hear it. Even talking about menstrual issues with other women can be embarrass.

Why are women's bodies seen as abnormal? Women are the ones who are asked to adjust to 'the way things are.' Another example of this is the number of female urinary directors (more or less funnels that let women pee like men) and uneven toilet ratios that cause long lines for women. There are those who say women just need to go faster or need to deal with it or need to remember to carry supplies, but why are women's bodies seen as the abnormal, as the exception? Imagine, if you will, what it would be like if restroom facilities were based on women's bodies and needs. There would be more toilets, more safe design, more mirrors. And there would always be menstrual supplies available, and even perhaps wipes to help clean up menstrual waste in the restroom.

Before you say that that's too much, what if these were the normal supplies in a restroom, the standard set, just as toilet paper and soap are? Toilet paper and soap are the primary needs of men in restrooms; women require more. Public restrooms initially came up as only for men; that assumption has never been changed in the architecture and design of restrooms.

Every woman has, at one point or another, not had the right supply when they need it. It is difficult to deal without it: not using anything can cause an embarassing marking on one's clothes and fashioning a substitute from toilet paper can be problematic because not only does it leak quickly but it can shift. While some places have vending machines, they frequently don't work. So I think this app might be a fun idea, but the fact that there is a need for it--that somehow women are expected to use community ties to adjust to an architecture and system that is designed around men's bodies--is evidence of the quiet influence of patriarchy in modern lives.

2012 bill in India seeks to address manual scavenging

Manual scavenging, or the human disposal of human feces, is a common problem in many developing countries. Manual scavengers face an onslaught of health problems from close contact with human waste and the social oppression and stigma. No where is this more codified though than in India, where manual scavengers are the lowest of the "Untouchable" castes (or, as activists will refer to themselves, "Dalit," or "the oppressed").

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The Hindu, India's largest newspaper, features an article by Agrima Bhasin, an alumnus from University of Oxford and an independent researcher in Delhi. In his article, Bhasin discusses a new 2012 bill to more aggressively fight manual scavenging, comparing it to a 2011 bill.

Something to address manual scavenging is necessary. In spite of the fact that a 1993 law banned manual scavenging, an estimated 1.3 million Dalits in India still make their living through manual scavenging in some form: emptying dry or pit latrines by hand, emptying septic tanks, working in the sewer system, or cleaning human waste from railroad tracks. The new law would heighten the severity of the punishment for the employment of manual scavengers.

The new bill, though, as Bhasin points out, is inadequate when it comes to allowing manual scavengers to improve their lives: taking away their occupation is less positive thing when social stigma does not allow them to gain more meaningful and less degrading work elsewhere.

If you're interested, definitely read the whole article.

The big flush?

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According to BBC and other news sources, the city council of Bulawayo, Zimbabwe's second largest city with a population of 1 million, are asking all the residents to simultaneously flush their toilets in order to clean out the pipes.

Zimbabwe has been suffering a severe drought. Residents in the town of Bulawayo have only 72 hours of water a week. Two of the city's five supply dams have dried up, and the situation is unlikely to get much better until a proposed pipeline is built--a project not slated to be completed until 2014.

The prolonged drought has led to sewage building up within the system while residents wait up to three days sometimes to flush. Pipes have already reported to have burst from the dryness and weight of the waste. This flush will help clear all the waste from the system.

Residents are not entirely pleased.  "Our leaders are a joke," says one resident. "What they should be doing is finding money from donors to buy new sewer pipes."

If there is an engineer who can explain how this would work to me, I would appreciate it.
 

Going in tanks and other links

My friends are awesome. They send me links about all kinds of sanitation-relevant things. Unfortunately, I don't have time to write a post about all of them, so here is my mix:

In 2009, a Russian gentleman was granted a patent for disposing of "biological waste" in tanks: go in a specially-design hollow bullet, and shoot it at the enemy. The Guardian writes, "This method of warfare aims to kill the enemy's spirit and psyche."

Meanwhile, over in India, Rural Development Minister Jairam Ramesh says that if the state Uttar Pradesh achieves open defecation free status, he'll believe that Sai Baba, Indian spiritual leader and mystic, is still alive. He openly declares the need for making the bureaucracy easier.

And CNN made a three and a half minute video segment on the problems of open defecation in India. (Does anyone else think that showing pictures of people openly defecating ethically problematic? You wouldn't show a white person going to the bathroom.)

Toto, maker of super toilets, has compiled a list of toilets in the US that have one of their super toilets.

Saturday Morning Breakfast Cereal, one of my favorite comics, publishes a comic on self-flushing toilets.



 

The urinal next to yours: an actual academic study

In one of my favorite parts of the movie French Kiss, the fiancee calls Meg Ryan from Paris to confess that he has found a new love: "I've never felt this way before. Like I could do anything. I could rule the world, climb the highest mountain. I could walk into the men's room and pee, even with some big guy standing behind me." "What?" she gasps in disbelief.

Anxiety about urinating with other people around is a long-standing joking discussion, primarily relegated to comic movies and the internet. (The number of videos, articles, posts, etc. online that come up when you search "urinal rules" is incredible. You can look for them yourself.) If there are three urinals, you are expected to use the one farthest away from another person. (Such rules about the maintenance of personal space extend to other spaces as well, including buses, restaurants, computer labs, etc.) General experience and anecdote, however, is not enough for some researchers.


Googling "urinal rules" gets a whole wealth of these images.

From the vast archives of strange and questionable academic studies, I bring you, "Personal Space Invasions in the Lavatory: Suggestive Evidence for Arousal" by R. Dennis Middlemist, Eric S. Knowles, and Charles F. Matter. (Journal of Perosnality and Social Psychology, 1976, Vol. 33, No. 5, 541-546).

The investigators were interested in why we have such a strong desire for personal space. Their hypothesis was that proximity causes arousal, and that arousal is "interpersonally stressful" and produces "discomfort." ("Arousal," in this context, is not referring to sexual arousal, but more general emotional arousal.) However, these investigators were dissatisfied with the means of measuring arousal in the other studies they read. Heart rate? Skin conductance? Palm sweating? Interesting, but not good enough. Not...close enough for these investigators.

So...urinals. Investigators can invade personal space without deviating too much from the norm. There is little chance for escape. And (as the fiancee in the beginning of this post could attest), anxiety or stress makes it difficult to urinate, delaying the beginning of urination and shortening the duration of the event. Perfect, right?

The investigators begin with the hypothesis that, "If personal space invasions produce arousal, then subjects standing closest to others at lavatory urinals would show increases in the delay of onset of micturation [urination] and decreases in the persistence of micturation.

To observe the behaviors around urinals and proximity, the investigators placed an observer at the sink of the bathroom and had him pretend to groom himself. Using his wristwatch, he would record the time between unzipping the fly and the beginning of urination and the time the 'persistence' of the urination (from start of flow to end). He took note of this by the sound of the urine hitting the bowl.

Of the 48 people they noticed at a US university campus,
--none would pick a urinal next to another person (which I'm sure comes as no surprise to anyone)
--23 were separated by one urinal from the next user
--9 were separated by 3 or more urinals

Interestingly enough, though, there was an average delay of 7.9 seconds of those only one urinal away compared to those who chose farther distances. The urination lasted longer as well, with 19.0 seconds with one space on average, 24.4 seconds with two spaces, and 32.0 seconds with three or more spaces.

This was just their pilot data, to try to see if this was a legitimate means of inquiry. Since they did not randomly assign who was at what distance, their data could show a self-selection bias: maybe those who choose to urinate with only one urinal between them and another person were just more anxious in general, which accounts for the delay in micturation.

In the real experiment, the investigators artificially and randomly would select the personal proximity difference by placing a confederate next to the subject or removing a urinal by placing a "don't use" sign on it. This meant that the two people in the bathroom (confederate and subject) would be forced to be approximately 16-18 inches apart. A user of the urinal was considered a subject if there were no other people present during the urination except for the investigator and confederate. To collect the data of time and persistence of micturation, an observer was stationed in a stall. During the pilot studies, however, they found that the observers had difficulties in precisely hearing the action. How they worked around this--well, I'll let them explain: "The observer used a periscopic prism imbedded in a stack of books lying on the floor of the toilet stall. An 11-inch space between the floor and the wall of the toilet stall provided a view, through the periscope, of the user's lower torso and made possible direct visual sighitngs of the stream of urine."

Yes, the investigators chose to spy on the men at the urinal using a periscope hidden in a stack of books. Apparently it was "ok" because they couldn't see the men's faces. (Incidentally, I came across a reference to this article made in a research methods book as an example of dubious ethics. Before you find yourself afraid of all university bathrooms, the ethics board training that all investigators must complete and the board which they must get all of their work passed by explicitly prohibits observational studies in places where participants expect a degree of privacy--such as a public restroom.)

But they got results. Their results showed an average 6.2 second delay in moderate distance conditions to 8.4 seconds when the confederate stood directly next to the person. This is compared to 4.9 seconds in the control sample. The persistence of the micturation (the time they were actually urinating) also varied noticeably, with a control condition of 23.4 seconds compared to 17.4 seconds in the close distance condition. (Unfortunately, I can't do a more in-depth analysis of their statistical techniques, since I don't have that background.)

Their experiment shows, indeed, that how close you are to the person next to you does affect the delay of onset of urination and the time spent urinating.

I really wonder whether this whole experiment was worth it. Yes, some degree of "arousal" is somewhat inevitable with proximity, but is urination time really somehow better than the other methods they dismissed in measuring emotional arousal? Skin conductance is commonly used in biofeedback machines in counseling centers to measure stress for therapeutic reasons. Can urination delay and persistence be that much better? And more importantly, does this conclusion justify the invasion of privacy that this entailed? Subjects were never informed that they were in fact, in a study. Subjects were put through discomfort in what is an incredibly private place. You could not get a modern ethics board to pass this.

What we can actually get from this study, though, is the degree to which personal space and boundaries become all the more salient in restroom settings. Restrooms which have inadequate boundaries lead to a greater degree of muscle tension, resulting in a decreased time of urination and thus a more incomplete emptying of the bladder. This, subsequently, can lead to an increase in health problems, such as urinary tract infections. It helps point to the idea that boundaries are very important in designing restrooms--adequate space needs to be between urinals and walls on stall need to be low enough to create a comfortable visual barrier.

What I think I'm going to take away from this study the most, though, is the mental image of a guy in a toilet stall looking through a hidden periscope, watching streams of urine, and feverishly writing times down.

Why do I bet that this was probably some poor grad student?


Extra bonus quotes:

"Urinals are open and placed side by side so that, under crowded conditions, men stand shoulder to shoulder, coactively engaging in private elimination."

"The restroom contained two banks of five urinals, which were bowl type rectangles jutting out of the wall and containing about 3 inches (8 cm) of standing water, which the user flushed."

Running the numbers

I recently underwent TA training for my university, where I had to do a ten minute presentation on whatever I wanted. (Ok, it was supposed to be something that we were going to teach, but I decided to do some shameless promotion of the importance of sanitation instead.) My presentation was on "why shit matters." Someone came up to me afterwards and said, "Thanks for your presentation. I didn't realize how big of a problem it was."

This got me thinking that perhaps not all of the people reading this blog realize how important sanitation is. So let me introduce you to some numbers.

2.5 billion people

Number of people who don't have access to "basic sanitation," defined as being sanitation that is "hygienic" and separates waste. Practically, it means they're openly defecating, using buckets, "flying toilets" (plastic bags they throw out the window), or "dry latrines" (bricks on top of the ground you sit on to defecate).
This is 1/3 of the planet.

1.6 million people

Number of people who die every year from diarrheal diseases, including cholera. These can be prevented through clean water and proper sanitation. 90% of these deaths are children under 5. More people die of diarrhea than typhoid, AIDS, and malaria combined.

 

146 million people

are threatened by blindness from trachoma.

6 million people

are visually impaired from trachoma.

This is more people than are in the entire metropolitan Washington DC area.

 

133 million people

are suffering from "intense" intestinal helminths.

This is equivalent to approximately 42% of the population of the United States.

 

If the health impacts don't motivate you, here are some of the economic impacts of sanitation on various countries' GDP's:

 

India: 6.4%

Cambodia: 7.3%

Benin: 1.5%

 

Is this really acceptable?

Toilets of the future

I've had several friends (thanks Malcolm, Drew, Holly, and Van!) send me articles about Gates Foundation's Reinvent the Toilet Campaign's Fair in Seattle that ran from August 14th to the 15th. This is a campaign I've been very interested in. For those of you who haven't heard of it before, I'll let their snazzy video show you what it's about:

Gates Foundation is on the front of recognizing and acting on the realization that clean water is not effective without sanitation.

The toilet today is pretty much the same one that was invented a couple hundred years ago. While we've updated all other technologies, this one has pretty much kept the same. In "developed" countries, toilet flushing is the number one use of domestic water. It is a major waste of one of our most precious resources. In developing countries, the flush toilet is impractical, requiring a huge and complex infrastructure and vast quantities of water.

Gates Foundation has recognized this and decided to tackle it by coming out with a challenge: reinvent the toilet. Make it environmentally safe, make it cheap, make it possible for developing and developed contexts, and make it pleasant to use. (I particularly applaud the last one, as this is often overlooked in these discussions.) They issued the challenge a year ago, and on August 14th, they announced the winners.

First prize of $100,000 went to California Technical Institute, near Los Angeles, California. (This is the same university, incidentally, who oversees Jet Propulsion Laboratories, who put Curiosity on Mars.)

Loughborough University in the UK won $60,000 for their second place entry. Their toilet "transforms feces into biological charcoal (biochar) through hydrothermal carbonization (decomposition at high temperatures without oxygen and in water) of fecal sludge." It will be powered by burning said biochar and will recover water and salt from the waste.

                                      

University of Toronto in Canada won $40,000 for its design that sanitizes feces for resource recovery through "mechanical dehydration" and "smoldering" (low temperature, flameless combustion) within 24 hours while urine is zapped with a UV light.

Eawag, the Swiss Federal Institute of Aquatic Science and Technology, won an honorable mention for the user interface of its urine diverting toilet.

You have to admit, it does look pretty.

What do these disparate designs have in common?

1) They're decentralized. They don't need to be plugged into some massive state infrastructure.
2) They don't create massive amounts of waste that needs to be managed by a government or personally scooped out by anybody.
3) They create new resources from "waste."
4) They don't suck to use.

So what next? The fair brought together hundreds of designs, but new toilet designs aren't going to be that helpful if they're not built or bought.

Alfredo Behrens of Harvard Business Review's blog asks, "Are you ready?" for the demand of markets in India and China. The largest supplier of toilets in the world is Roca, in Barcelona, which sold 32.5 million units in 2010. This is nothing in comparison with Behren's estimate of a coming demand for as many as 150 million toilets in India alone. Is it possible that these new toilet designs can enter the market this way?

Another possibility might come from a government-subsidized retrofitting of old houses in cities where the sanitation infrastructure is falling apart. Instead of investing in a crumbling infrastructure or expanding it in urban sprawl situations, what if the government paid for toilets like the ones I've discussed, that would not require they be plugged into a larger system?

The possibilities are tantalizing. With technical innovation working to push the sanitation revolution farther along, it's up to policymakers, business people, and everyday people to help carry it even farther.

From pine cones to paper--history of toilet paper, part 2

The gap in the histories I've found is fairly large once we get past the Romans and their sponge sticks. As you might know from desperate experience, a variety of materials can (and have been) used to wipe.

The Chinese are "widely" agreed to be the first people to make paper for that use (and by widely, I mean the internet articles agree). According to this site, a Chinese official in 589 BC mentioned using paper to wipe; later, an Arab visitor in 851 AD also confirmed that the Chinese were using paper. Things didn't get fancy until 1391, when the royal family would have 2 by 3 feet perfumed sheets made for themselves to wipe.

I'm going to make an enormous leap forward in time to 1857, when a New Yorker named Joseph Gayetty marketed the first known toilet paper as "Gayetty's Medicated Paper."


Source

It same in single sheets, was imbued with aloe, and every square was monogrammed with his name.

Source

Toilet paper doesn't appear on a roll, though, until 1871, when a gentleman by the name of Seth Wheeler, of Albany, New York, filed for a patent for perforated paper on a roll.

Source

However, toilet paper on a roll really didn't get rolling (sorry) until the Scott Paper company picked it up in 1879. When they first released the product though, the Scott company did not want to soil their family name with such a vulgar product. Instead, they used the names of their distributors, which came out to some 2,000 different names. In 1902, they purchased the WALDORF (R) trademark (like the Waldorf hotels), and they subsequently started selling under that name. The company streamlined their processes, and by 1925 Scott Paper company was the leading brand of toilet paper in the world.

But how do you market something which you basically just use to wipe yourself, then throw away? How do you market a product that relates to a vulgar, lowly bodily function that people really don't like talking about? (1925 was after most of the big city clean-ups and the sanitization of the Americans, so shitting was becoming serious shaming territory.) Arthur Scott came up with one of their best slogans: "Soft as old linen." He tied a product that is generally tied with shit to a luxurious product and comfort.

Fortunately for the Scotts, indoor plumbing and hygiene awareness was on the rise. Riding this wave, the Scotts began to market their product as a health-promoting product. By marketing it as such, it allowed them to advertise in magazines such as Good Housekeeping. By talking through a medical lens, a lot of topics that are taboo become acceptable.

1930s advertisement
Source

It was supposed to help stop the spread of dysentary, typhoid, cholera and others; whether it actually does, is up for debate. However, it might be more sanitary than using one's hand if using one's hand is not combined with rigorous hand-washing; conversely, toilet paper is less effective at removing feces from the anal region.

Their marketing worked; toilet paper was an official part of American life. During the Great Depression, Scott Paper did not have to lay off a single worker. Charmin is founded in 1928, when a female worker commented that the packaging was "charming." Charmin sought to appeal to women by making their packaging fashionable, with a woman's cameo.

Like a lot of history and a lot of our habits, much of our behavior has been influenced by a few clever men and good marketing campaigns.

Today, toilet paper is still commonly used in Europe and the US. Many of us are quite fond of it and struggle with trying to use other methods (myself included). However, toilet paper is responsible for 27,000 trees being cut down every day. Toilet paper, furthermore, can be quite taxing on sewage systems, frequently requiring more water to transport the waste. So next time you're somewhere and you have the chance to use a bidet or a lota, why don't you try it? Who knows, you might like it better.

Or maybe we should go back to the sponge on a stick?

More on washing later.

Did you know...

In the 19th century, one type of scavenger in London were the "pure finders": "pure" is another word for dog feces. They would scavenge dog feces from the Thames (which was, at the time, a giant sewer) and sell it to tanners, who would use it to clean leather.

Not a precise picture of a pure finder, but a mud lark, another scavenger of the Thames.
Picture from London Labour and London Poor (1861)
Source

How the Romans wiped (history of toilet paper pt. 1)

There are two types of people: those who clean with water after defecation, and those who clean with paper. I've already discussed the company Who Gives a Crap and their philanthropic toilet paper. Gizmodo posted a brief article on the history of toilet paper that a friend was kind enough to bring to my attention.

The Romans used to use sponge sticks:

Source

Romans had some of the most sophisticated restrooms in the world, with dual streams of water: one for defecating in, and another to rinse off the sponge stick which you shared with all of the other guests in the restroom. The wealthy Romans, however, would use scented water.

The Toilet Paper Encyclopedia has a fairly fascinating historical list of different materials people have used throughout history to wipe, including:

Wealthy French: lace, wool and hemp
Middle Ages: hayballs, a scraper/gompf stick kept in a container in the privy
Early Americans: rags, newsprint, paper from catalogs, corncobs, and leaves
Viking Age/England: discarded sheep and lambs wool
Hawaiians: coconut shells
Inuit: snow and Tundra moss
Sailors from Spain/Portugal: frayed end of an old anchor line
Medieval Europe: Straw, hay, grass, gompf stick

It's a fairly eclectic mix, but consider, if you will, what people use: trash, right? Things that are discarded. This makes sense, of course, because (for the most part, anyway) you don't want to keep anything that has shit on it. But wiping is an intimately physical act--these materials get close to a part of our bodies that very little gets to get close to. We have to be ok enough with these external items to let them come to an internal part of us.

Or is it that way? Instead, is there a shared concept amongst these groups that defecation is a "trash" process that is external to other parts of our self? We don't wipe out face with a Sears Roebuck catalog page, but we will wipe our ass with it. Our concept of our body is inherently divided and hierarchical; some parts of us are more intimately associated with our concept of our selves (faces, for example, are some of the most important parts of our bodies with this) and others we have distanced ourselves from (the anus).

For more on toilet paper in history, be sure to check out the Virtual Toilet Paper Museum (yes, it exists) for a fascinating and addicting photo gallery. This story of toilet paper and what we can learn about people from it will continue in later posts.

**UPDATE**
Check out part two of the history of toilet paper here

Travel toilet photos

When most people travel, they take pictures of waterfalls, beautiful landscapes, fascinating people.

I do that too. I just also take photos of toilets.

Toilet in the hotel in Addis Ababa, capitol of Ethiopia. I was mostly interested in this one because the toilet is a rectangle. Does anyone know of anywhere else in the world the toilet seats are rectangles? It seems counterintuitive, since our buttocks are more round than rectangular. If you're wondering, it's not quite as comfortable.

This picture is the latrine of a school in rural Ethiopia. The school is in bad shape--when it rains, the children don't go to school, because the stick and mud structure is falling apart and cannot keep out the rain. Many places in Ethiopia don't even have a latrine. This one doesn't have running water, which is a biggest problem for not only hand washing, but also for young girls who are dealing with menstrual waste.



For complete contrast, this is the toilet in the palace of Haile Selassie, former emperor of Ethiopia from between 1916-1974. I don't know exactly when it was built. The bathroom also includes a bathtub and a bidet.

And now for the opposite...
Toilet in the hotel at my research site, a rural farming town near Jimma. It's as disgusting as it looks. We tell people that toilets are cleaner, but when their experiences look (and smell) like this, do we really think they'll believe us? I would rather have gone in a field.

Now, my friends are doing it for me too. This pictures if a medieval toilet in Salzburg Castle in Austria. She couldn't get closer, but like most medieval castles, it's most likely to operate on shitting in a hole that hangs out over the edge of the castle walls.

If you have toilet pictures, send them to me!