Water, cholera and silence on shit

We are born, we eat, we shit. And so it continues till at the end we pass on. We talk about birth, about maternal health, choices we have or don't have on birthing methods, on reproductive rights. We most definitely talk a great deal about food which, if you stand on most streets and look around, seems to be in abundance even though in Haiti and other parts of the global south, millions, are food insecure, an easy to manage way of saying at risk of death from hunger.

THE SILENCE

But when it comes to shit, there is silence. Where does it go, how is it removed, what happens to it? In this instance I am talking about Haitian shit -- but shit is shit as they say. The only difference from country to country is what happens to it after we have, at least metaphorically, flushed the toilet. I don't know where Haiti falls in the hierarchy of shit management, say compared to my own country Nigeria which I don't think is that great. I suspect that most of the global south remains challenged by sanitation as well as food and water.

We know that in certain situations shit can kill and the poorer you are the more likely you could die of a shit-related illness. Cholera is a prime example, so shit is a poverty issue and a class issue. We know there are issues of privacy, access to ‘toilets’ especially at night and sexual violence in unlit densely populated urban areas, so shit is also a gender issue. We know that some people risk physical violence or are refused entry into toilets such as a proposed ban in Arizona where transgender people would not have the rights to choose a toilet; so shit is also a transgender issue. With shit playing such a prominent part in our lives, why is what happens to it so mysterious?

In 2009 DINEPA [1] was created to take control of the management of water and sanitation in Haiti. Prior to that, the management of water was minimal with little regulation. Various initiatives had been created in the past such as CAMEP, set up by Francois Duvalier in the 1960s, and much later the neighbourhood water committees created during President Jean-Bertrand’s first presidency. Sanitation management though was close to zero. The earthquake changed everything, though not for everyone! There are still only six people to service the sanitation needs of 10 million people. Seriously how is that possible?

2010 EARTHQUAKE

The earthquake changed everything because at that point water and sanitation became a crisis issue which was again taken to another level with the October 2010 outbreak of cholera. The cholera outbreak has now been proved to be a direct result of cholera infected shit from a UN camp being introduced into the Artibonite River which is a source of water for thousands who live in the area. 8,000 people have died from cholera - a shit and water related bacterial infection. Thousands of children were made orphans during the earthquake and more thousands have been orphaned through cholera. Families left destitute as the main breadwinner died from cholera. Shit kills!

Since the 2010 earthquake the role of DINEPA has become more crucial as it forms a major part in the management of the prevention of cholera and other illness. This is done through its camp monitoring work consisting o : Data collection - information gathering of water, sanitation and hygiene; municipal coordination mechanism which analyses data - water supplies, number of working toilets, desludging [nice word for shit removal">. All of these are crucial in a country with a cholera epidemic that could get out of control at any given moment particularly as the rains begin next month. The danger was put to me by Oliver Schulz of MSF:
‘My personal fear is that things will get worse before they get better. The structures are weaker today than in 2011/2012. Every year the structures deteriorate. There is no plan for cholera and without a WHO supported comprehensive national health care plan with clear directives, clear action plans and milestones then it will not get better. Also many of the big agencies have left and there are too many unknown NGOs, charities and faith groups.’

CRISIS OF CHOLERA

At this moment, cholera is a crisis. Access to clean water is a crisis and sanitation levels are a crisis. The refusal to see these as crisis is a major contribution to the crisis itself. Despite these crises the United Nations which has refused to receive the claims of Haitian cholera victims for compensation claiming immunity under the UN’s 1946 Convention is suggesting that 99 percent of the cholera elimination programme be funded by the private sector. Read Haitians will have to pay and pay hard for clean water and sanitation. As one official said to me, private companies are always ready to cut corners for profit so you cannot trust them. The Haitian government and its partners in exploitation - The Clintons, USAID, Canada, France, Corporations - have two solutions for Haiti and neither have the interest of the popular masses who make up 80 percent of the population. The first is charity which is invariably unsustainable and merely papering the gaps. The second is to privatise Haiti so even the supply of water becomes an opportunity to profit from earthquakes and disease.

Removing the shit

To return to the shit situation, there are two ways of desludging: mechanical and manual. The former uses a truck with a pump which extracts the shit from the septic tank which if you can afford it, is made of blocks and cement. This is the system I grew up with in Nigeria and remains the way it is done. The shit is then removed but no one ever talks about where the shit goes. In Haiti the mechanized method is also used in the camps. In Port-au-Prince [PAP"> the pumped shit is taken to one of two newly built treatment plants. The plants provide 500 cubic meters for 500,000 people which means the two plants are only meeting treatment needs of 1/3rd of PAP's population. Although the camps have the benefit of a mechanized system the rest of the city does not. And here lies one of the problems. The post earthquake crisis has meant the focus for water provision and sanitation [as well as rape and other forms of sexual violence"> has been concentrated on the camps leaving millions living in poor neighbourhood with minimal or no support.

However the majority of desludging is done manually in the depth of the night by Bayakou - men who literally stand in the pits and remove the shit. Unfortunately rather than get respect for doing the worst job imaginable, Bayakou's are stigmatized which might be why they work at night. Once exposed, they are often victims of violence so very often they live secret double lives. Bayakous do not live long. Imagine you are in the pit and cut yourself, the wound soon becomes infected plus your liver is compromised after regularly drowning yourself in alcohol to remove the smell and taste. Bayakou are unregulated and no one asks where the shit goes. The government has been trying to formalize manual desludging and provide the men with proper protective clothing and regulate the disposal and to some extent this has been started in the Cap. But when there is so much anti-shit bias where no one wants to discuss any aspect of shit management, it is a slow process.

SHIT is the dark side of life, and until it is cool to brag about how my shit is removed and treated or recycled and used for compost or we begin to look at shit as a health issue, change will be slow. Along with access to clean affordable drinking water, management of shit are central to healthcare and the prevention of cholera.

LAST WORD - UN IS RESPONSIBLE FOR CHOLERA

The NGOs and International aid agencies came and now most of them have left. Many of those that remain are scaling down their services of water, sanitation and healthcare provision. DINEPA itself is not sure how long it will be fully funded and inevitably something or someone will loose and it won’t be the UN or the private sector. To quote Oliver Schulz again there is simply no plan.

In the hope of obtaining justice and reparations for the thousands of cholera victims, the Bureau des Avo­cats Inter­na­tionaux [BAI"> and Institute for Justice and Democracy in Haiti [IJDH"> filed a groundbreaking suit against the UN on behalf of 5,000 cholera victims. In addition to insisting on accountability the suit demands that the UN

• Install a national water and sanitation system that will control the epidemic;
• Compensate for individual victims of cholera for their losses; and
• Issue a public apology from the United Nations for its wrongful acts.

After the demands were dismissed by the UN, Haitian civil society will proceed with their campaign to for the UN to meet their demands. In a joint action CSOs, released the following press statement on Cholera in Haiti in which they demanded the UN pay reparations for the 8,000 dead; demanded the UN / MINUSTAH admits to its responsibility in introducing Cholera; develop a sustainable programme with consultation from the population for elimination of cholera; Present an apology to the Haitian people worthy of the greatness and pride of the First Independent Black Republic in the free world:

Par devant cette situation inacceptable, nous, AUMOHD, Erzili DLO, BAI, Batay Ouvriye, SOFEJH, CCDH, FEHATRAP et des d’Organisations de la Société Civile, des Organisations populaires, des Organisations des victimes comptons lancer un appel à la mobilisation générale et de faite lançons un appel patriotique, humanitaire et de dignité au nom du PEUPLE Haïtien à l’ensemble de la population mondiale pour :
1.- Forcer aux autorités Onusiennes/MINUSTAH de RECONNAITRE leur faute relative au cholera en Haïti.
2.- Réparer dignement les 8.000 victimes et autres
3.- Eradiquer de manière réaliste avec la participation citoyenne l’épidémie du cholera en Haïti
4.- Présenter au Peuple Haïtien des excuses dignes de sa grandeur et de sa fierté de la Première République Nègre libre et Indépendante du monde.

[1] National Directorate for Water Supply and Sanitation in the Ministry of Public Works
* The article is based on a series of conversations over the past two months with MSF staff, human rights lawyer, water and sanitation officials, community organizers and neighbourhood residents. The conversations are ongoing.

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