Toilets Save Eyesight

This article deserves to be above the fold in the New York Times. Very insightful. Summary: if you want to prevent preventable blindness, you need to consider sanitation and safe water. Don't stop the surgeries, don't stop the antibiotics, and perhaps most importantly for the longrun, don't neglect the Facewashing and Environmental Sanitation parts of the SAFE strategy.

Zambia – Toilets save eyesight, new study confirms
November 16, 2009

CALGARY, Nov. 16 /CNW/ – Why in the world is an organization dedicated to the treatment and prevention of blindness spending money on toilets?

“Because believe it or not, toilets and blindness are directly connected,” says Pat Ferguson, President & CEO of Operation Eyesight. “Proper sanitation and clean water are in short supply in the developing world and that contributes to a high rate of unnecessary blindness and other serious health problems.”

A new study conducted by Zambia’s Ministry of Health and supported by Operation Eyesight found that trachoma was 28 per cent more likely to strike in households that do not have proper toilet facilities. The study, which covered five districts in Zambia, found that up to 80 per cent of the households surveyed do not have toilets.

“Trachoma is caused by a bacterium and is easily spread from person to person and by flies which breed on human waste,” says Ferguson. “So it’s no surprise that proper sewage disposal helps to prevent this horrible disease.”

Trachoma is the world’s leading cause of preventable blindness. In parts of Zambia and Kenya where Operation Eyesight supports development projects designed to eliminate trachoma, up to 30 per cent of children age one to nine years are infected.

Without treatment, trachoma causes a person’s eyelids to turn inward so that the eyelashes constantly scrape the eyeball. It is extremely painful and can lead to permanent blindness. The World Health Organization estimates more than 80 million people are affected by trachoma and about 8 million suffer the advanced stages of the disease and are visually impaired.

Operation Eyesight’s trachoma projects are designed to both treat and permanently eliminate trachoma. The projects follow the World Health Organization-endorsed SAFE strategy which includes Surgery to treat the late stage of the disease, Antibiotics to eliminate infection, Face washing and hygiene promotion, and Environmental change including water wells and latrines to prevent re-infection.

To be effective, the ambitious projects require construction of thousands of latrines, drilling hundreds of wells, mass distribution of antibiotics and training thousands of citizens in hygiene and well management.

“These projects are large and costly,” says Ferguson, “But the benefits are enormous. In addition to preventing unnecessary blindness, the SAFE strategy dramatically reduces other serious diseases, helps keep children in school and saves women the need to walk many kilometers in search of water, which is usually unfit for human consumption.”

Operation Eyesight is working in close partnership with the governments of Kenya and Zambia and is a member of GET2020, the World Health Organization initiative to eradicate trachoma from the entire world by 2020. For more information about Operation Eyesight’s trachoma projects, visit www.operationeyesight.com.

Operation Eyesight is a Canadian international development organization dedicated to preventing and treating blindness throughout the world for more than 45 years – primarily in South Asia and Africa. We help local medical professionals provide comprehensive, sustainable eye care and community development for the people of the world who can least afford it. Since 1963, Operation Eyesight has restored sight to more than two million people and provided blindness prevention services to nearly 33 million others. For more information, visit www.operationeyesight.com.

Global Blindness – Every five seconds, one person in our world goes blind and a child goes blind every minute. More than 90 per cent of the world’s blind people live in developing countries, where day-to-day life is already challenging and blindness is a direct threat to life. About 80 per cent of this blindness is preventable or treatable.

Source – NewsWire

I’ll be damned if I’m gonna pay to take a piss

Direct quote from a tourist during a recent trip to Paris: “I’ll be damned if I’m gonna pay half a euro to take a piss. I’m going to McDonald’s!”

So people have a difficult time paying to go to the bathroom in France. Not exactly a newsflash, and I think the same will be said once public toilets start becoming more prevalent in NYC. Tourists will still whistle nonchalantly through hotel lobbies to get away with doing their business for free.

In several woredas (districts) in Ethiopia, however, it’s now the hip thing to not only have your own pit latrine by your home, but to pay for the privilege. How did this happen, and in Ethiopia of all places, where the per capita GDP is $US1,000, and where only 6% (sic) of the population has access to improved sanitation facilities? What’s the secret?

Trachoma is the world’s leading cause of preventable blindness, and is caused by a lack of safe water and inadequate sanitation facilities. Transmission of trachoma can be decreased significantly by using improved sanitation facilities like pit latrines. The Carter Center’s Trachoma Control Program, in cooperation with the Ethiopian Ministry of Health, launched a program in 2002 to catalyze the building of 10,000 pit latrines to stem trachoma. If there is one global public health story over the past few years that deserves to be above the fold in every mainstream periodical, it is this one:

Pit Latrines for All Households: The experience of Hulet Eju Enessie Woreda, Amhara National Regional State, Northwest Ethiopia

The full report (in Amharic) is a bit of a read. The gist of this executive summary (in English) is this:

• 89,000 pit latrines were built (the actual number is now 225,000)
• Ethiopians have for the most part done this themselves
• Most households paid nothing for their latrines; of those who paid anything, the median amount was USD$2.80.
• The secret to success was not throwing money at the problem, or pushing some inappropriate top-down technology or infrastructure.

The secret to success is what the Carter Center calls "community mobilization, the presence of a strong political commitment among local leaders, and integration into the pre-existing community structures and practices." The latin taxonomic name for that is “Ethiopicae grandmae,” less technically “Ethiopian grandmothers,” or “informal village leaders.”

Pit latrines do not sell themselves in most cases, particularly in rural and peri-urban areas where the need to find an unspoiled place to leave a #2 is less urgent because there is simply more real estate. Latrines are frequently expensive to build and maintain, even if the local demand exists. It is often very difficult even to create that demand though, particularly in more rural communities, and difficult to ensure that those latrines are used for their intended purposes, not as homes or as cow-dung storage sheds.

This particular Carter Center program did not have the resources to build latrines themselves, but only to do the community mobilization and training. I spent several years in the late 1990s working for USAID and U.S. Department of State contractors on democracy and governance initiatives throughout Africa. Not infrequently I found that the fewer financial resources we had available for a project, the more successful it turned out to be. This was because less money led to non-financial commitment(s) being provided by local leaders, and by women’s groups in particular. Once those local commitments were made available, the sustainability of our work increased dramatically.

This Carter Center report indicates similar results from a similar approach. If Patty Stonesifer would come to me today with the “How would you spend $5b” question, my answer would be “Scale the sanitation work of both the Carter Center and Sulabh International by customizing their approaches for every country/community in the world, and blow the sanitation MDG out of the water.”

It is not cost-effective to vaccinate a newborn against polio or mumps if that child will die at three years old from a preventable waterborne disease like diarrhea or malaria or be forced into a life of leading a trachoma-blinded adult around for the rest of his/her life.

“Using a pit latrine is freedom, comfort, and honour!” — Villager from Hulet Eju Enessie Woreda