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PLOS BLOGS Speaking of Medicine and Health

Telling Toilet Tales—Celebrating the Eleventh Annual World Toilet Day, November 19, 2012

What would it be like if you had no toilet and no running water in your home? Not only for a brief time for a power outage, say, or while you’re remodeling your bathroom, but as a way of life. And none of your neighbors have them, either. Nor the next town over.

Today is World Toilet Day, started in 2001 by the World Toilet Organization to raise awareness of the enormous health and psychological challenges faced every day by the 2.5 billion people worldwide who have no access to adequate sanitation. A staggering 1 billion of these people have no facilities at all, and practice open defecation.

Our developed world is blessed with many advantages, including sanitation systems that are so good, so complete, that we’re not even required to think about this daily activity. We go, flush, wash our hands, and we’re done. Going without an indoor toilet or running water is an adventure for a few days of camping. Some of us even romanticize lack of plumbing as part of the “simple life,” something we long for in this complicated modern world.

I lived without indoor plumbing for four years. This was not in a far-flung part of the world, although for some people Maine is flung far enough to seem like another country. The house was unfinished; it had electricity and wood heat, but money had run out and plumbing was complicated and expensive, prone to freezing in winter, subject to town building codes, and in a way unnecessary: there was an outhouse and a well (with an electric pump, no less!). Relatively speaking, it was more than adequate. But “simple”? No, far from it.

Day or night, rain or shine, as it’s said, when you gotta go, you gotta go. And so you went.  Where I lived, you walked down 200 feet of uneven path that wound through the woods, over protruding roots and stones, to the outhouse. It was a small, one-seat pit privy—simple, but tidy and private, with toilet paper in a coffee can (protected from marauding varmints and drenching rain) and a thin wooden shingle to fan away flying insects in summer.

The Outhouse

Of course, in winter, if you had to go “smell the lilacs”, you first bundled up against freezing rain, sleet, or snow, which wind gusts drove between the boards of the small building and down the back of your neck.  In summer, biting insects attacked mercilessly while you sat trying to concentrate. Ah yes, the mosquitoes–and greenheads, blackflies, deerflies, horseflies, and moose flies. Wasps, hornets, and yellowjackets. Ticks. Spiders. Junebugs that hit you in the head at night as they maniacally flew toward the light in the house windows. You had mosquito bites on most parts of your anatomy all summer long.

I envied a neighbor who had built a beautiful, sturdy little ‘house and painted it white inside; it was a two-seater with a vase of pretty dried flowers, pictures on the walls, and reading material. It was not a pit privy – they made their “deposits” in plastic bins, which they then composted for their garden.

Taking the cue, I built a simple but comfortable seat-and-bucket “inhouse” according to toilet plans in the very funny and very practical book, The Humanure Handbook*, by Joseph Jenkins.

The “Inhouse”

After years using an outdoor privy, it was bliss to simply step into the next room to do what had been inconvenient and was sometimes an ordeal. This system required more manual maintenance than the outhouse had, mainly in the form of me staggering with a bucket of sloppy, redolent muck in each hand to the composting area, dumping them on the pile without splashing the mess on my person, and scrubbing the buckets clean with detergent and hot water. It was worth the effort to have an indoor facility; and after the compost had aged, I added it to my raised-bed garden and it went mad—I had unprecedented production of tomatoes, greens, squash, rhubarb, herbs, flowers, and berries. I confess: I was proud of the system.

I lived without running water or an indoor toilet for four years, but I was far luckier than billions of my fellow humans: I had privacy, security, a constant supply of toilet paper and soap for hand washing. I never got sick from it, and when I wanted a good, long, hot shower and a flush toilet, all I had to do was get in my car and drive to town, 15 minutes away. I had all the resources I needed to build a basic system with which to handle our “waste” and create compost for my garden, which further contributed to our good health.

On that note, of course, sanitation is not a sexy topic. It is outright uncomfortable for most people to talk about. The very topic is even taboo in some cultures, including our own. As Rose George, author of The Big Necessity, said, “it’s possibly the most unappealing public health crisis in the world.”

The UN’s ambitious Millennium Development Goals show this clearly: sanitation was tacked onto Goal 7, Environmental Sustainability. Target 7C: “halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation.” It’s wedged between 7B (“reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss”) and 7D (“by 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers”). And unlike the goal for water, progress toward this goal continues to lag behind schedule.

Why is such an important, basic, and pervasive problem pushed to the side? A problem that even had its own year (2008 was International Year of Sanitation). Clarissa Brocklehurst (Chief of UNICEF’s Water, Sanitation, and Hygiene section and a PLOS Medicine author) put it bluntly: “I think we have to face up to the hard fact that sanitation is unpalatable because it is about shit.”

Indeed. But to address a problem, we need to learn to speak of it easily and courageously. Let the conversation begin! We’d love to hear your toilet stories or thoughts in the commenting area below. Learn more about the Last Taboo from the Community-Led Total Sanitation site. And find out other ways to participate in World Toilet Day.

* The book includes chapters called “Crap Happens,” “Deep Shit,” and “A Day in the Life of a Turd.” Highly recommended reading. It has been translated into 14 other languages and is available for free download at

Do you Give a Shit? Explain why in the
“I give a shit because…” field on the WTD website.

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