Count to 15. Stop. One more child has died of diarrheal disease. In the developed world of flush toilets and plumbing, diarrhea is trivial. It is the squits, the runs, a stomach bug, a joke. But in the right circumstances, diarrhea is deadly. It needs a little help to get started, but that is easily provided by a range of viruses, bacteria or worms that infect human intestines, sapping necessary nutrients and liquids from the body. If salt, sugar and clean water are not replenished, diarrhea can cause severe dehydration and death, in only four days.
The squits kill more children every year than HIV/AIDs, malaria and tuberculosis put together. (Every 15 seconds. There’s another.) The death toll equals a jumbo jet full of children crashing, every two hours, every day. Efficient, lethal, easily available: diarrhea is
a terrific weapon of mass destruction.
When cholera broke out in Haiti in December 2010, it was headline news. Since then, it has killed 5,000 Haitians. Since then, nearly 2 million children have died from the dozens of other infectious agents that cause diarrhea, but you won’t read about that in most papers. Cholera – caused by the highly infectious bacterium Vibrio cholerae – is terrifying: catch it, and you can be singing at breakfast and dead before lunch. But cholera is only one diarrhea-causing infection. There are no TV cameras recording the death of three-year-old Sunita in Bangladesh from rotavirus; or two-year-old Marie in Liberia, who had E. coli with her rice.
It’s not just cholera that gets more attention. Everything does. Madagascar’s HIV/AIDS budget is five times that of sanitation, though, in 2008, UNAIDS couldn’t find any AIDS deaths to record (14,000 Madagascan children die with diarrhea every year). Ninety-five percent of most water and sanitation budgets in developing countries go to providing clean drinking water, with sanitation an afterthought.
Cleaning up drinking water reduces disease by 20 percent.
A latrine cuts it by double that.
It doesn’t add up. Cleaning up drinking water reduces disease by 20 percent, a latrine cuts it by 40 percent. But gushing taps are photogenic. Celebrities like to promote clean water; none wants to be photographed by a latrine. At least doctors know the value of sanitation: the readers of the British Medical Journal, when asked to vote for the best medical advance of the past two centuries, chose the toilet. (Anesthesia came second.) If only politicians could do the math.
Hungry? Today’s special is fecal particles. It was the same yesterday and it will be the same tomorrow. If you or your neighbors have no toilet, and excrement is lying around your house or village, you will have microscopic pieces of excrement stuck to your feet, mouth, fingers and hair. You probably can’t taste, smell or see them, but you’re still eating and drinking them for breakfast, lunch and dinner. People without sanitation probably ingest 10 grams of shit a day. It is inevitable and easy: A child poops outside, there is no water or soap, and his fingers are soon dipping in the family rice-pot. A dog wanders through the bush where your neighbor defecates and brings fecal particles home on its paws. Chickens, pigs, rats, children, adults: shit isn’t fussy. As the diagram of contamination pathways above demonstrates, anything with feet and fingers can transmit fecal particles into fluids and food. Enjoy your meal.