Friday 19 November 2004

I get fed up with Keep Fit Day, Wrong Trouser Day, and other ‘special’ days. But World Toilet Day really matters. For me, the lavatory is the greatest medical breakthrough. Forget heart transplants; forget even penicillin; sanitation has saved more lives than anything else in history.

In British towns until the 1830s the infant mortality rate was 50 per cent; of all the babies who were born, only half of them lived to be five years old. The others were killed by dysentery, typhoid, diarrhoea, and the newly imported cholera. They died because the drinking water was contaminated with sewage. Then came piped water, proper sewers, and the ubiquitous water-closet, which separated the sewage from the drinking water. Infant mortality in this country is now below 1 per cent because of better sanitation, among a range of advances.

But the developing world has been left behind; in Zambia, for example, 20 per cent of babies die before they are five. In the time it takes you to read this article, a dozen babies will have died from easily preventable diseases caused by poor sanitation.

The answer is not water-closets for all. Even in soggy Britain we scarcely have enough water, because the water-closet is so wasteful. Every time you flush the loo you throw away several litres of expensive drinking water, which has to go off to a complex treatment plant to be recycled.

In 1860 the splendid Henry Moule, Cambridge graduate and vicar, patented an earth-closet. The water-closet, he said, is an abomination, for it simply shifts the problem downstream. Sewage has to decompose somewhere, and by flushing it away you are wasting excellent fertilizer, and condemning the stuff to rot slowly under water in the cold. In contact with dry earth, however, sewage dries out and decomposes aerobically in a few hours. No pathogens; no smell.

Following his advice, I built my own earth-closet – essentially a commode with a bucket inside, and a supply of dried earth from the garden - a trowelful to be sprinkled on top of each offering. The family used it for a month in the summer, and were impressed. Little trouble, no smell, and a luxurious growth of beans in the vegetable patch.

How does this relate to the world problem of sanitation? In poor countries 2.6 billion people have no access to lavatories; many simply go in the bush. This is ok for men, but a nightmare for women, and especially girls. Often the girls have to wait in discomfort until after dark, when they risk being molested by men or by animals. Lack of clean, private school lavatories also prevents girls from getting an education, particularly after puberty. Of all children who fail to go to school, 60 per cent are girls.

Then there is disease. If sewage is not disposed of safely, and you have nowhere to wash your hands, you are bound to get contaminated. Urine is usually sterile, but a teaspoonful of faeces contains several million bacteria, plus, in many places, eggs and larvae of parasitic worms.

Millions of babies die. Millions of women are in distress. The solution is to build latrines and simple washing facilities. There are well-tried designs, from the simple pit latrine costing as little as £5, to the ventilated improved-pit (VIP) latrine, to the twin-vault composting privy, which costs around £15 and provides fertilizer to improve crops. A school latrine for 360 pupils and teachers can be constructed for £300.

All you need is a pit, ideally brick-lined, a concrete slab on top with a hole in the middle, and a hut around it built from local materials. Rosemary Mande and her family built their own VIP latrine in their village in Zambia. The construction work took them six days, but she says, ‘Before I just used the bush, but since having the latrine it is so much cleaner. Everyone is much happier now.’

To provide everyone in the world with adequate sanitation would cost another £10 billion a year, which is less than we in the west spend on pet food. That is why World Toilet Day matters. You can help through WaterAid; phone 020 7793 4500 or visit their website www.wateraid.org.