Tuesday, August 6, 2013

The last post

Hello all!

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

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

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

Well, I guess it's time to finish.


Wednesday, July 31, 2013

Pee-powered phone

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

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

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

Thursday, July 18, 2013

Rainbow urinals remind men to wash their hands

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

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


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

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

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

So 65% of men at Penn State?

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



Wednesday, July 3, 2013

Ends and means, rape and sanitation: setting priorities

 **Potential trigger warning. 

Public health is a wonderful field full of motivated and energetic people with a real drive to do good in the world. There is ostensibly something elegantly uncontroversial about many of the goals of global health: you’re preventing people from dying from preventable or curable diseases. You’re saving lives. While other programs are sticky with politics and controversy, health programs keep people alive, and that is good.
            This is the kind of narrative that has attracted many people (myself included) to the field of public health. In this whole mess of a world, we can at least we can do this—get children a headstart in life by encouraging their mothers to breastfeed, give people clean water, immunize people against diseases. But this kind of thinking has resulted in a tendency to have a end-oriented perspective: the ends justify the means. Preventing children from dying is important and good, and this is an end that justifies its methods.
            This is the sort of thinking that led to some of the brutalities of the smallpox vaccine campaign: lies and manipulations of government officials, doors kicked down in the middle of the night, children held down and forcibly vaccinated. The harsh memories from those days lingers on in these places, and it hinders current vaccination work and collaboration. Yes, we eliminated smallpox, and that is incredible—but what was the cost?

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

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

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

I believe in sanitation. I believe in its importance to change lives for the better and its importance in ensuring health. But I do not think there is any justification for measures that rely on the degradation of women. These are older, powerful, male villagers who said this. They are seated in places of privilege. With the government and NGOs looking at them to decrease open defecation, they are strongly motivated to decrease OD in order to maintain or increase their prestige. When they say they will not arbitrate rape cases, they are telling young women that their bodies, their rights, do not matter as much as their status. They are telling men that it's open season on any young woman you see after dark, because you can always say they were out defecating.
The next sentence is, “Therefore the extreme poor were compelled to install toilets.” How sad, really. Instead of wanting to install toilets, instead of being worked with to improve their sanitation situation, they are threatened—the threat of the awfulness of rape or by the loss of honor that would come with having a female in the household raped.
Most approaches—this one included—are multipronged, so it’s difficult to point out what particular aspect of any approach was effective. So I cannot argue with this approach on an effectiveness level; we cannot say, Well, at least it’s effective or This wasn’t even effective.
But effectiveness isn’t the point. While yes, open defecation put the whole community at risk, does that really excuse these kinds of threats against individuals? Furthermore, what do you think people will remember next time a development group wants their cooperation?
The struggle for better health for all (which is really what we’re in this for) is a long, long struggle. Impatience leads to collateral damage. ‘Ends justifies the means’ behavior leads to other problems in other areas down the line. In trying to save people, let’s not make their lives worse.

Wednesday, June 26, 2013

Surprise! People don't always make healthy choices

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

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

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

My favorite part of the story is the following:

GREEN-LOWE (employee of CARE implementing clean water in Kenya): I've had malaria five times now. I have a bed net hanging above my bed and I don't use it.
REPORTER: Why don't you do it?
GREEN-LOWE: It's 45 seconds. It's a burden. I don't want to. I either don't think about it or feel stubborn.
The story closes out with the following observation: “People everywhere - in rural Kenya, in New York, wherever - we just don't always do all the things we're supposed to do.
Why is that a surprise?

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

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

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

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

Saturday, June 22, 2013

Great speakers in toilets

I'm working on some projects, so enjoy some mini posts in the meantime.

Rose George wrote one of my favorite books, The Big Necessity, which shifted my interest from water to sanitation. I recently found out she did a Ted Talk on why sanitation is important. Check it out:

Monday, May 27, 2013

Racist toilet knick knack

When I saw this, I just had to share:

Yes, you saw that correctly. That is a black (presumably African) boy in an outhouse, with another one waiting. The text on the bottom says, "One moment please."

For only 50 dollars, you can be the proud owner of this. The Etsy description reads:

Old Black Americana Figurine, Little Boys Toilet Outhouse Collectible, Japan

Vintage ceramic Black Americana figurine statue depicting two African American little black boys at an outhouse. One is already using the toilet, as the other eagerly waits. Bottom of the outhouse reads, "One Moment Please".
Very very good condition for it's age, with some paint wear, but no chips or cracks.

Measures approx: 3" tall & 2" wide
Marked as shown: Occupied Japan / Made in Japan
I don't know much about Japanese culture (and I'm up to some other things currently), so I'm going to refrain from analyzing this one. But if you want some of my thoughts on people's fascination with the bodies of the Other, then check out an old post of mine, "Only brown people shit." 

Saturday, May 25, 2013

Heroin users and the silence of shitting

***This post contains graphic content.***

Taking heroin makes you so constipated, it’s a nightmare…The heroin makes you constipated so you won’t go to the loo for a couple of weeks, two, three weeks. So then I’ll take, not a huge amount [of Epsom salts], but I always end up taking too much, but it does, it clears you out…Being constipated is quite nasty, and I mean horribly, horribly. It’s like bloody coal mining, the agony and the pain. Putting your bloody fingers up your bum to pull out bits of, like, fucking diamonds. It’s not nice, [it] really is not nice.

Neil sits at the table in his parents’ kitchen across from the interviewer. A freshly-washed suitcase dries out in the sun. Tomorrow, he’ll be leaving for three months of residential detox and rehabilitation for his heroin habit.


            In the April 2013 issue of Medical Anthropology: Cross-Cultural Studies in Health and Illness, Lucy Pickering, Joanne Neale, and Sarah Nettleton published “Recovering a Fecal Habitus: Analyzing Heroin Users’ Toilet Talk.” As part of their larger work on drug users, they found themselves talking to many of the heroin users about shitting—how agonizingly painful it is. Neil had been asked broadly about the physical effects of heroin, and instead of focusing on oblivion, sores, illness, drowsiness, contentment as many of the other users had done, he had focused on this: the painful betrayal of the body to do a basic function which Neil did not have to even think about before.
            We don’t talk about shitting very much. There is a silence around the topic. Even in Phillipe Bourgois and Jeffrey Schonberg’s book, Righteous Dopefiend, a profoundly beautiful and detailed ethnography about homeless heroin users in San Francisco, constipation caused by heroin use was never mentioned. The literature on shit is pretty sparse in comparison to just about every other topic. We don’t talk about our bodily functions with other people; it’s part of being in society.
When we’re little, we learn how to use the porcelain potty, and then once we have mastered that, we also master the silencing of discussing our bodily functions. This trajectory is a mirror image of the one that has happened in human history. Historically, shitting was a communal act (see Roman public toilets or English peasants). We could talk about it. But as history as progressed, the silence and the taboos around bodily acts—farting, blowing one’s nose, shitting—have increased. Furthermore, it became a function of class. The upper classes did not want to smell like the lower class; by suppressing their bodies, by asserting control over them, they asserted their supremacy. This goes all the way back to the Cartesian mind/body dualism issue—the idea that mind and body are separate. In that frame, mind is usually privileged over the body. Controlling one’s body shows one’s strength of mind.
            In the authors’ narrative about the heroin users, the users were more open about their defecating when their excretory systems began to malfunction from the drugs. (Opioids increase the amount of time stool takes to move through the gastric system by increasing nonpropulsive contractions in the middle of the intestine and decreasing propulsive peristalsis—in other words, they make the muscles that move things through your intestines mess up.) As the drug users became increasingly marginalized in society, they also stopped partaking in the silencing of their body functions.
            More plainly, marginalized people suddenly get to talk about marginalized things. To reverse the equation, people who talk about marginalized things become marginalized. (What would happen if you started talking about shitting all the time? …Exactly.)
            So what if people really need to talk about defecating? If we put so many layers of silence on top of defecation, how can people really get the help they need? This is true not only for heroin users, but what about patients who are using opioid-based medications? The elderly who have problems managing their defecation? It’s embarrassing to talk about. If people feel like they can’t ask for help, when they do, we marginalize already marginalized populations.
            Pickering, Neale, and Nettleton delve into this silence in an academic space with a marginalized, ‘othered’ population. It’s a place to start, but only start. There’s a lot more that needs to be done to eliminate this cultural silence so we can help people better manage their bodies and lives.

Monday, May 13, 2013

Five reasons toilets and cell phones are different

For some reason, several of the sanitation-related articles I’ve read in the past few months have had the same statistic: on the planet today, there are more cell phones than toilets! (That’s only one link, but search ‘toilets and cell phones’ and you’ll see the ubiquity of the comparison. There is some slight variation in that some articles say that cell phone coverage is better than toilet coverage, but same idea.) GASP! We need to make toilets like the smart phones, says the Copenhagen Consensus report—we need to make everyone want one!

I’m not certain whey we ended up with this cell phone and toilet comparison. Maybe because we keep dropping our phones into toilets.

Whatever the reason, I’d like to suggest five reasons why toilets are not like cell phones.

1) One’s a necessity, and the other is a nicety.
Perhaps the reason that this comes up all the time is that from over here, cell phones are seen as a nicety, whereas toilets are a necessity. We remember a time without cell phones, right? We survived. But toilets—geeze, you need those. Right? And toilets are so low-tech. Ha ha—isn’t it so strange and quirky that people have cell phones but not toilets? (Note the subtext: weird foreigners with stupid priorities.)
However, think about people’s priorities. Cell phones let you do business. It’s quickly becoming a necessity for people at all levels—the rickshaw driver in India or the bajaj drive in Ethiopia needs to have a phone to conduct business. People use cell phones to let each other know the water tank prices so their relative the next village over doesn’t get ripped off. They use it for transferring funds and banking. Farmers can use it to find the best price for their goods
Toilets, on the other hand, are a good experience, but the financial benefit is indirect. It’s hard to point out to a community that hey, you saved money this year, because you built toilets and didn’t get sick. And to see real health effects, everyone in the community needs to get the toilet. One family without a toilet puts the whole community at risk.
So if you were someone in a developing context, which would you pick?

2) One people have control over, and it works.
You can have two kinds of toilets (it’s an over-simplification, but bear with me): self-managing, decentralized sanitation systems or state managed systems. There are also some NGO managed systems, but those are much more rare. The self-managed systems, such as composting toilets, pit latrines, or any other system that relies on the family or individual to directly manage the waste of their latrine, are often the ones that end up breaking down or not being maintained because maintenance can be expensive in terms of time and money.
State-managed systems, on the other hand, rely on the government to be in charge of the maintenance of the infrastructure that takes the waste away and (hopefully) do something with it that’s slightly better than dumping it in your backyard. This is what we have, and what many places strive to have. (Yes, the government won’t hire a plumber to deal with your toilet clog, but most of the waste management process is paid for with taxes.)  In many countries, the state is not managing these systems. If someone does choose to pay for a toilet, they must constantly invest to maintain the system, with time (as in scooping out a composting toilet) or money (like hiring a service to pump your tank). And this is for something that, as mentioned in #1, there is not necessarily a super-direct benefit that is evident.
Cell phones, on the other hand, you can buy from your local wala or shop owner and have a nicely functioning device with a system that is maintained by a series of entrepreneurs and corporations. You just have to put money in the system occasionally, which is a pretty simple process. You can charge your phone with as much money as you want or have. Other people can charge your phone. (One of the sweetest things someone has ever done for me was to charge my Indian cell phone from across the country so he could call me and tell me good-bye.)

3) One of these is more important to men.
Most articles talk about how good sanitation is positive for women and girls. This is something I agree with, especially when good sanitation facilities are coupled with water facilities that allow women to have good menstrual hygiene. But toilets are more important to women. Men can just piss in a corner. The argument too, that having a toilet increases prestige is more intimately tied into the female role as being the manager of the household. 
In most cultures, men are the primary earners. As mentioned above, cell phones are becoming a necessity for the acquisition of not only economic capital, but social capital as well (ie, making friends, creating a network of customers). Cell phones support male roles; toilets are a more feminine issue. Given that men still usually control financial flows (I’m sure we can complicate that claim, but can we just not right now?), men are going to be more likely to spend money on a cell phone than a toilet.

4) One of these items deals with shit.  
With the possible exception of Japan, people aren’t into toilets much as a commodity item. It’s a place where we perform one of our most taboo bodily functions. Smart phones, on the other hand, you can pull out of your pocket—show your friends. Look up where you saw that one actress. Find directions. Play games. Distract a two year old. Smart phones are all about active utility.
Toilets, on the other hand, tend to have a much more passive utility—they don’t really do something awesome. Toilets are awesome—they make solid waste disappear so we don’t ingest as much of it. It means I can not have a smelly neighborhood. But again, that’s a passive utility. It’s a prevention mechanism. We’re glad it happens, but we (generally) don’t get excited about it. Smart phones you get excited over and show your friends. Toilets are about concealing a body function we’re incredibly ashamed of.

5) The world does not need as many toilets as cell phones.
Think about it. Yes, there are more cell phones than toilets, but how many people will use a single cell phone? Often times, about one. Maybe a whole family. Cell phones often need to be with you for them to be of use, limiting the number of users a single cell can have. Toilets, on the other hand, can be used by dozens of people. Yes, some articles compare cell phone coverage with toilet coverage, which is a far better way to talk about it, but others cite raw numbers. 

So yes, there are other reasons that cell phones are not like toilets. (Only one of them is supposed to be sat on.) It’s still a tragic statistic, especially when you discuss it in terms of coverage and not just numbers. But making this comparison threatens people to try to find solutions in the realm of cell phones. These are not the same problem. Cell phones have found success in Africa in great part because of market deregulation, but given that toilets often have little direct benefit, are gendered problems, deal with human shit, and require an extensive cleaning process, will the free market really tackle the sanitation problem?

Saturday, May 11, 2013

Coming back

Hello readers!

So, I took a far longer hiatus than expected--a master's exam, finals exam period, and some family things later, I'm trying to get back on the saddle again. (Why does that sound like a toilet euphemism?)

I've been seriously considering shutting down the blog--it takes a lot of time, and I keep getting the sneaky feeling that the only reason my page hit count is so high is because when you Google image search "Roman sponge stick" an old post of mine is one of the top results. I got discouraged about the endeavor--I felt like I was talking to myself.

But when I logged in to write my "farewell world" post, I saw that some of my old posts have hit counts that aren't from Google image searches. So maybe--hopefully--someone is reading my blog who didn't just end up here because they were Googling "Roman sponge stick." (Who the heck DOES that, anyway? Besides me.)

So well, yes, I'm coming back, and yes, I'll work on a post with actual content. I still would LOVE to have guest contributors--on anything, really. If you want ideas, I will share ideas with you.

Thanks all, and I'll be posting soon!

Monday, March 11, 2013


Hello readers,

So, as you might have (or have not) noticed, I've been rather quiet of late. This is due to a confluence of personal, professional, and academic factors that have meant that I have not had the time or energy to devote to the blog. I thought I would make a sort of official announcement that I won't return to blogging until April.

However, if anyone wants to write a guest blog post, I would be very happy to throw them up here! My e-mail is jen [dot] anne.barr [at] gmail [dot] com .

Have a great March.

Friday, March 1, 2013

How to shock a celebrity and irritate an anthropologist

So, recently, the internet plunked this video in front of me:

For those of you who didn’t care to watch, it begins by showing the reactions of a series of celebrities to a particular video. Their reactions range from shock, disgust, horror. The viewers are left in suspense—what is this video that they have strong reactions to?

We are then treated to the video itself: a collage of parasitic diseases prevalent in the developing world: elephantiasis, river blindness, trachoma, schistosomiasis, trichuriasis (whipworm), ascariasis (roundworm), and hookworm. The photo and video collage alternates between people suffering from the diseases in visible ways (trachoma, elephantiasis) to the parasites themselves. I won’t deny that it is powerful to watch: these diseases are acutely painful (although not always fatal) and incredibly graphic. The video finishes with a plea to donate to their campaign to “End 7”: End 7 Diseases by 2020. According the End 7 Campaign website, a donation of 50 cents can provide the drugs to make one person parasite-free for a year.

In literature and linguistic analyses, there is something called a synecdoche, in which a part is made to stand for a whole. For example, if I say “wheels” to refer to my car or “hired hands” to refer to workmen. In this video, the pathogens they show, the conditions—these are synecdoche for human beings. The entire structure around illness—the politics and the economics that cause these people to live in conditions that lack the sanitation that would prevent them from getting these diseases—and the people themselves who have selves and lives outside of the illness were distilled into icky pictures of worms. Images of worms and images of people are quickly flashed together, and in many ways, rhetorically conflated. Think about that—people with trachoma = round worms.

People are not their diseases.
People with parasitic diseases should not be represented by their diseases.

Can you imagine what would happen if we tried a cancer campaign that represented people with cancer by images of their tumors? I felt nauseous just typing that, and I’m guessing that you probably have a strong reaction as well. Why do we think this is ok to do to people in different countries? We have different standards for media portrayal of people in different countries (as I have previously pointed out), and we need to stop it.

You could argue that I’m being over-critical, that as long as money is being raised for the cause, does it matter how we motivate people to act? It’s an important question, and one that different people have very different feelings about. But representations inflect how we think about others and how we choose to act in relation to them.

Watch the video again. If those are the kinds of images we have of people in other countries (and this video is far from being an outlier), then how do you think we’re going to act? Maybe you can just open up a newspaper and see.


Saturday, February 16, 2013

A shitty cruise


Recently you might have heard about Carnival’s ‘cruise from hell’. An engine fire last Sunday stranded passengers in the Gulf of Mexico on a ship without power. The situation was reportedly like a mix of ‘survivor’ and ‘Lord of the Flies.’ Passengers disembarked Friday and told their stories.

Perhaps the most graphic of the accounts (besides the panic, the hoarding of food, and the man who had  breakdown at a movie the cruise ship operators played to try to distract people) are those concerning the sanitation situation: on a cruise ship with 3,143 passengers and 1,086 crew members, the toilets stopped working.

 People urinated in sinks or just on the floor. Sewage dripped down the walls. Crew distributed red bags. It began to stink so badly on the lower levels that people made ‘tent cities’ on the top decks. Those who braved the lower floors slipped on the sewage. “The stench was awful,” said Robin Chandler, a 50-year-old from Dallas. “A lot of people were crying and freaking out.” The stewards were continually having to clean up after people who had defecated and urinated in random places. Upon return, another passenger scrawled “Triumph RIP: Rest in Pee” on a sheet with mascara and held it triumphantly aloft.

As soon as people did not have toilets that functioned how they were accustomed to using, they began to urinate and defecate—well, pretty much anywhere. People complained about using plastic bags. (These are called, in many parts of the developing world where this is common practice, flying toilets.) I just want to point out that these people were primarily Westerners from the developed world, and we attribute their behavior to the conditions. And yet, if we’re talking about people of developing countries, we jump to calling defecation behavior that does not conform to our standards as being “cultural.”

Let’s try to be more careful before we make judgments, shall we?

Wednesday, January 30, 2013

Only brown people shit

Have you ever noticed the great lengths that people go to conceal bodies and bodily acts in the US? Restrooms are hidden in difficult to find places and signage isn’t necessarily apparent. Two sets of doors (one right after another, creating a hallway) prevents outsiders from catching a glimpse of the inside. Sanitary products are scented to prevent revealing odors. Scented candles and potpourri in private restrooms conceal the activities of the previous occupant. Even news stories talking about obesity blur out the faces of people they show images of, even if the bodies on display are in “public” mode (ie, walking down the street just normally).
A picture from a channel 10 news article on obesity. Notice how the faces are carefully left out.
My point, rather unsurprisingly, is that we have a lot of anxiety about our own bodies and bodily actions. You won’t see depictions of people defecating in mainstream discussions, unless it’s for comical effect, shock value, or to point out their uncivilized behavior and deviant status (as in covering a news story of someone defecating on a police car in protest). We won’t even talk about it, unless it’s about infants or social deviants.
Contrast all that with this video from CNN, where the camera shows (quite clearly) people defecating on the railroad tracks. Their bottoms are blurred, but not their faces, protecting the viewer’s sensibility, but the not the anonymity or dignity of the people being photographed. You can find countless pictures of people defecating on blogs, news outlets, videos, and other visual media, but what do the people have in common?
1)      They are all men or children..
2)      They are all visibly impoverished people in developing countries.
3)      They are not blurred out.
(I don’t really want to go and find more examples for you all, but spend some time with Google and YouTube and you’ll come across more examples than you care to see.)
It is the bodily actions of the poor, racialized Other that can be on display, not our own, and certainly not women’s. The bodies of the Other are fair game for display. In their bodily practices we can see enacted their deviance from the norm. We can see their alien-ness. Their inferiority. Their dirtiness.
People might argue that it doesn’t matter to the people being photographed. These are people who are so poor that they can’t afford toilets—it’s not like their neighbors will see these pictures, right? It’s not like potential employers will see these pictures, right? But in a country like India, where there are more cell phones than toilets, the interconnectivity of the Internet can exist side-by-side with a lack of sanitation. As my colleague and fellow graduate student Aubrey Graham has researched, the photos we take and how we take them in developing countries can come back to these countries and result in dire consequences—stigma, anger, and sometimes violence. While I cannot think of any particular specific incident in which a picture of someone openly defecating has directly affected that individual’s life, I think it is unfair and wrong to force that risk upon already marginalized people.
[The following section may contain some imagery that sensitive readers will find disturbing. Possible trigger warning.]
But much broader than that, such discourse harkens back to 18th and 19th century European fascination with the intimate bodies of the exotic peoples. Saartjie Baartman, a black South Afrikaan woman born in 1790, was a part of an exhibition that travelled throughout London and Paris for five years under the anglicized name Sarah Baartman.

Anatomical diagrams drawn after death

She was advertised as the “Hottentot Venus” by the animal trainer who showed her off. She would emerge from a cage on a raised platform, where people would poke at her and wonder at the strangeness of her shape, wondering if her buttocks could be real. She was seen as hyper-sexual, as animal, and as not human.
French print from early 19th century: "La Belle Hottentot"
European observers say, "Oh God Damn, what roast beef!" and "How comical is nature!"
After her death, the French anatomist George Leopold Cuvier (1769-1832) examined her body in great detail. In particular, he was very interested in her genitalia, convinced that he would find anatomical evidence showing how she was naturally lascivious and animalistically passionate. Through his measurements, he claimed to find fundamental differences in her genitalia, and his examination of her came to stand in as the definitive study of all African women. He then proceeded to remove her genitalia, preserve them, and put them on display in the Museum of Man in Paris. Beverly Guy-Sheftall writes of this, “There is nothing sacred about Black women’s bodies, in other words. They are not off-limits, untouchable, or unseeable.” This is in contrast to the bodies of white people, and especially, white women.
Many of the chapters in Jennifer Terry and Jacqueline Urla’s book Deviant Bodies demonstrate the urge of European men to find explanations for or proof of social deviance in the bodies of those who society deemed deviant—prostitutes, nymphomaniacs, Black people, criminals. There must be something in the bodies of these people who explain their strangeness, how they are biologically (and thus, in their view, fundamentally) different than me: the size of the labia, the shape and size of the brain, and, in modern times, their very DNA. By rendering the differences biological, we render them safe—I cannot possibly be like that.
But I would argue that in the visual depictions of sanitation and defecating we are doing the same thing but instead of looking at the body directly as the source of abnormality and otherness, we look at practices of the body—which, really, are still very close to the body itself. Like Sarah Baartman’s genitalia, we can place the body practices of the Other in our modern museums—the images of the media. By visually depicting these bodily practices, we distance ourselves from them, dehumanize them, and, under the guise of sympathy, ensure ourselves that we are not them, that they are fundamentally different than us.
This has a tendency in manifesting in policies and programs that seem to be based on the idea that somehow people who are openly defecating or engage in bodily practices that are different than our norms are different in some way, that what motivates them are strange “cultural” reasons that we must decode. “Culture” becomes “body”, since it is not accepted anymore (most of the time, anyway) to talk about fundamental “biological” differences.
So as we fight for better sanitation coverage in the world, it is important to think of how we do it. What are the stories we tell with the pictures we take? And do we want those stories told about us?

Saturday, January 12, 2013

Chasing polio: Is eradication the right goal?

Last week, I discussed some of the aspects of the disease of polio and the history of the eradication campaign after the recent deaths of aid workers in Palestine prompted people to examine the campaign.

So, should polio be a global health priority?

Very few people die of polio. Very few (relatively) actually show any signs of polio. While the symptoms can be very dramatic and heart-wrenching, they are not common. I am not diminishing the suffering of those who are afflicted. But as I previously pointed out, so few people are actually afflicted.

Compare the number of people with polio to the number of people who die from just plain, old, standard diarrhea. While it’s difficult to measure (since it’s difficult to classify whether it’s ‘diarrhea’ or ‘bad day’), WHO estimates there are approximately 2 billion cases of diarrhea every year. 1.5 million children die every year of just diarrhea. It’s the number two killer of children under five (second to respiratory illness), and costs countries millions of dollars every year in healthcare and lost man hours. Vaccines do not address any of this. Sanitation does. Instead of spending vast quantities of social and financial capital trying to eradicate a disease that is not that fatal, perhaps the resources are better spent addressing larger structural inequalities that create these huge differences.

Do I sound like a broken record? Probably. Sanitation is important, and polio is another disease that emphasizes this. Structural methods, such as sanitation and water infrastructure, are more difficult, complex, and expensive to implement, and it is so much more difficult to tally the lives saved. Yet these sorts of long-term solutions are the way to make long-term, significant, and sustainable solutions to health problems.

Yet, if we give up, what is risked? There is the fear that if people give up on the polio campaign, then donor agencies will see the money as wasted, that these groups (whether governmental or nongovernmental) have given up and are not worthy of more funds in the future. There is a sense that enough money has been sunk into polio, that we need to keep spending or none of it will have been worth it. We like eradication. We like checking diseases off of our list, and we don’t get to do that very often. And yet, with the speed that diseases evolve and that people reproduce, we may have to face the fact that eradication is not the right goal. Instead, we should focus on improving whatever health issue is the most salient in the particular community.

~Public health priorities is an incredibly complex topic, and I have only just started to scratch the surface. For more information on polio in Pakistan and global health institution culture and politics, check out Svea Closser’s book Chasing Polio in Pakistan.

Sunday, January 6, 2013

Polio in Pakistan: challenges of and to eradication

In the past month, aid workers in Pakistan have been targeted by the Taliban. Six workers were killed in December and another seven were killed this past week in what is becoming a pattern of violence against polio vaccine workers in the country. According to the NPR articles, Pakistani militants have accused the vaccine program of being a Western plot to sterilize Muslim children. The CIA's use of immunization workers to uncover the location of Osama bin Laden increased hostility to the campaign. In response to the December shootings, the UN withdrew from participating in Pakistan's vaccination program, citing safety.

Polio is high on the target list for disease eradication. Smallpox is the only infectious disease that the world has successfully eradicated, and since that success--the world-wide outpouring of effort that resulted in smallpox being banished to lab experiments--other NGOs and health groups continue to dangle the goal of eradication in order to gain support for their cause. Gates Foundation has targeted malaria. Carter Center targets trachoma and guinea worm. Rockefeller Institute took up hookworm. And Rotary International has taken up the cause of polio.

What exactly is polio? Polio, or poliomyelitis, is a virus that enters the mouth and nose through contact with infected mucus, phlegm or feces and breeds in the throat and intestinal tract. It becomes absorbed into the blood and lymph systems where it incubates from anywhere from 5-35 days (one to two weeks on average) before symptoms might show. Most people, however, never show any symptoms, but they can still transmit the disease. Of those who do have symptomatic polio, most will only show mild symptoms. These include what you might expect from almost any mild flu: fever, sore throat, headache, vomiting. These will generally pass in a few days.

The polio that inspires so much work and fear and images of crippled children is when the poliomyelitis affects the central nervous system (brain and spinal cord). From there, polio causes paralysis, resulting in a lifelong problems with mobility and social stigma. (Most commonly, this paralysis affects the legs, but a relatively small percentage will die from the.) However, fewer than 1% of people who contract polio suffer from paralysis. Clinical polio, while tragic, is only fatal when it paralyzes the respiratory system, which occurs in 5-10% of the paralysis cases.

In the late 1940s and early 1950s, polio crippled almost 35,000 people a year in the United States. After Jonas Salk discovered a vaccine, the response was immediate and swift. Pictures of little girls in metal braces and crutches flooded media, urging parents to get their children immunized. The campaign worked--the fear and panic that had plagued the American people had mobilized them in participating in a mass vaccine campaign, successfully eradicating polio from the US by 1979. (The last cases of polio were in isolated Amish communities.)

Jonas Salk discovered the vaccine most of the readers will be familiar with. Four shots in the arm or leg of inactivated polio vaccine (dead polio virus bodies). In countries such as the US, these shots are given at two months of age, four months, six to eighteen months, and a booster at 4-6 years of age, part of the standard set of immunizations which American children are often required to have before entering school.

Jonas Salk had a little-known competitor, however, an Albert Sabin, who worked at Cincinnati Children's Hospital. He developed another vaccine, which he viewed as superior. Unable to get support for it in the US, he went to the USSR during the Cold War and tested it there. Sabin's vaccine is oral, two drops in the mouth, and is what is used in most mass vaccination campaigns in developing countries such as Pakistan. It is simpler to use, and, because it doesn't require an injection, runs less risk of accidental infection from non-sterile conditions.

With the elimination of polio from the US, public health campaigns grabbed the narrative of "we have this immunity, let the rest of the world have it too" to fund the Polio Eradication Initiative, a twenty-year, six billion dollar project that has involved two million people, making it history's largest public health campaign. The progress has been incredible, with only Pakistan, Nigeria, and Afghanistan still reporting cases. However, the success is tenuous, with recent outbreaks in the DRC and Chad, and children being born every minute who need to be vaccinated to keep the disease in check.

We tend to conceive of polio vaccination as being a simple four part program. But in places like Pakistan and India, ten or more doses of the vaccine spaced a month apart are required to confer immunity on a child. Poliomyelitis thrives in warm places with high population densities and poor sanitation--in other words, India and Pakistan. Svea Closser, author of the book, Chasing Polio in Pakistan: Why the World's Largest Public Health May Fail, writes:

"In 2006, surveillance data showed that in 93% of districts in Pakistan, the median number of OPV [the oral vaccine] doses that children under five had received was more than 7; it was more than three in 99 percent of districts. Put simply, if immunity to polio required, as in the United States, only three doses of vaccine, poliovirus would have already been eliminated in Pakistan."

To get the ten or more doses into every child is an incredible feat, with a lot of challenges. Next week, I draw on Svea Closser's ethnography to examine the challenges and the assumptions of polio eradication, and I'll speak some public health heresy and ask, Is it worth it?


Tuesday, January 1, 2013

Happy New Years and my top 5 posts from 2012

Happy New Years everyone! It's back to Atlanta and back to blogging. I hope you guys had a great holiday season.
It's hard for me to take a few days off of work and study. I keep seeing things that inadvertendly remind me of work.
My boyfriend and I went to Disneyland over the break, and I couldn't help but notice that not only was the women's restroom poorly designed, but really should have had low-flush toilets. It is southern California, after all, and water is one of our most precious resources.
But between the poop jokes at my research (I think an inevitable part of my life now, thanks to my research), I managed to take a few days off and relax, and am now ready to attack the new year like a caffeinated cheetah! (Ok, maybe not yet. Give me a few days to recover from New Year's Eve.)
It's been a lot of fun blogging this past year, and I've been really flattered at the positive response. I'm trying to get back into the swing of things back here in Atlanta, so I've decided to be a bit lazy and jump on the "looking back on 2012 list" bandwagon. Here's a look at my top 5:
1. By FAR, my post, "How the Romans wiped: the history of toilet paper part 1," has been the most popular of all my posts. (Check out part two here!) I guess we're all a bit curious about these things. I also can't help but cringe when I think of the Roman sponge sticks.  
2. My post on Code Red! an app for that time of the month seemed to strike a cord with a lot of my readers, especially my female ones. Public restrooms are perhaps one of the most evident ways in which inequality is literally physically constructed in the world.
3. I was a bit surprised at the popularity of my post on airplane bathrooms that I wrote back in July. I guess there is something rather mysterious about the airplane toilet. After a 27-hour plane ride, I had fun scouring the internet to figure out how it all works.
4. From the annals of weird academic studies, this post, "The urinal next to yours: an actual academic study," discusses a psychology experiment in which the scientists used a periscope hidden in a stack of books to examine how long it took someone to start urinating when someone was using the urinal next to theirs. Incidentally, I came upon this study as an example of "studies that won't pass the ethics board anymore."
5. This post, "Sit or squat?", engages in the debate over which is healthier. I've loved how people have responded--I've even had friends tell me that they're half-way tempted to install a squat toilet in their own home. (I know I want one.)
So thanks for reading, commenting, submitting, or chatting!

Join me sometime within the next week when I discuss polio in Pakistan, and how the polio vaccine works when you're not in the US.