The Call of Nature

The call of Nature by Muhammad Atif Sheikh

40 Million Pakistanis Defecate Openly

Imagine for a while, you are a guest or a host and you want to answer the call of nature, but there is no toilet in the house, nor you have the facility of public toilet outside your house. What will you do in this situation?

Forty million Pakistanis have to face this situation daily. The most simple and easy solution they have is to excrete in open air at a place where they may find a bit hiding; it may be a farm or a tree, a bush, a bank of the canal or a river, forest, etc.

The call of Nature by Muhammad Atif SheikhAccording to the World Health Organization (WHO), Pakistan is the third country in the world after India and Indonesia where a huge population — forty million people — defecate openly. It is so because 17% houses in Pakistan do not have the facility of toilets. Figures of Pakistan Social Livings Standards Measurement Survey 2013-2014 confirm this fact and intimate a great difference in the ratio between urban and rural areas. According to the survey, only one percent households in Pakistani cities do not have the toilet facility whereas 26 percent of those in villages are deprived of it.

Why is it so? If people in villages build houses for residence, then why don’t they care for constructing toilets in those? All the inhabitants in the rural areas of Pakistan in this regard have more or less the same story to share:

“Mubashar from 425 EB Burewala, Punjab, says, “Our village has a social problem that most of the people in the village go to the farm to answer the call of nature. There are many reasons behind it. Firstly, it has become their social tradition. Then comes the shortage of financial resources to construct toilets in their houses. The people also do not have the awareness that the construction of toilet in their houses provides privacy and convenience. Another important reason is lack of a proper sewerage system in our village. Therefore, flush system toilets cannot be constructed here. If sewerage lines are laid by local authorities here, then toilets can be constructed in the houses.”

The call of Nature by Muhammad Atif SheikhBahadur Ali, who lives in village Wadda Mehar, in Sindh province states, “I go out of my house to relieve myself because drains are not constructed in our village. Therefore, we go out of our house to excrete in ravine.”

Kamran from Shabqadar, Khyber Pakhtunkhwa, reveals, “The male members of my village use outdoor toilet because our elders still prefer to go out of the house to defecate. Following them, the youngsters also don’t use toilets. Another problem in this regard is scarcity of water. When we hardly get water for drinking, then how could we use water in toilets? Another most significant reason is that the villagers do not construct toilets in their houses due to poverty.”

Javed, a resident of Heronak village of Turbat, Balochistan states, “In our village, even today people go out of their houses to excrete; its major reason is poverty. People do not have enough money to construct toilets in their houses.”

According to the Institute of Population Studies, Islamabad, fifty-nine percent population of Pakistan now resides in the rural areas where a large number of houses do not have the facility of toilets. Therefore, they go to the open places for defecation.

Moreover, according to Pakistan Social Living Standard Measurement Survey 2013-2014, the process of using open areas for excreting is still on in rural Balochistan more than any other province because 35 percent household of rural Balochistan do not have the toilet facility while 26 percent of those in rural Punjab are deprived of this facility. Similarly, 24 percent rural household of Sindh and 22 percent of Khyber Pakhtunkhwa have no toilets. In these conditions, if a person relieves himself in the open air, he disturbs others and makes them ill.

Dr Farrukh Mahmood, an expert on Water, Sanitation and Hygiene, while explaining their point, states:

The call of Nature by Muhammad Atif Sheikh 3 copy“We say it’s a ‘Call of Nature’ and whenever we receive this call we have to attend it. As we know that there are many kinds of germs in human excretion that cause diseases like diarrhoea, dysentery, cholera, typhoid and Hepatitis A. Moreover, among all the medicines the human beings use, 90 percent are expelled from the body through urination. So as long as the human excreta lie in the open air, flies and insects will definitely sit on it. Then these flies and insects carry the filth that sticks to their legs to the eatables which are not covered. Thus that edible stuff becomes severely polluted and infected. In rainy season, the water of the rain takes human excreta to nearby ponds or the stores of drinking water that causes gut diseases. Here, I want to clear a misunderstanding that some people think that there are no germs in excreta of the children. This idea is absolutely wrong. Then there are old people or physically disabled or special persons. This issue becomes more severe in their case because they are unable to walk. Therefore, they have to urinate and defecate around their houses. Thus the possibilities of spreading infections and disease increase much more.

Our body works as an automatic system. We are unintentionally breathing. Our heart is also palpitating. Our entrails are also working. We should not create an obstacle in their working. No doubt God has created the capacity of endurance in the human body. The man can also delay answering the call of nature for a while, for a few minutes or for half an hour. There might be several compulsions. It is quite different if there is no way out. However, this delay may be due to compulsions or a deliberate one, it puts undue stress on our system that stops working. There is another point that if someone retains urine for some time, human bladder has the capacity to bear it for a while but it adds up more and more. Then a time comes when the pain starts and the valve of the bladder opens up automatically and urine is passed as in the case of children.

In the same way, if we want to bring entrails’ system in our control, it is impossible and it also creates problems. One of the major problems is constipation. When we continuously stop our entrails from their natural work, they stop working and cause constipation. Constipation leads to many other illnesses and piles (bleeding with passage of stools) is at the top of the list.

Another point is that if we do not dispose human excreta scientifically and safely and do not keep our atmosphere neat and clean, we cannot stay healthy. It has a great concern with healthy atmosphere, particularly to wash hands before cooking, taking meals and after using the toilet is the most essential.”

To defecate in open in villages has negative effects on human health. Moreover, it puts sanctification and safety of girls, boys and women at risk. Therefore, it is necessary to have the facility of toilet in each and every house of Pakistan. It is among the fundamental rights of human beings to have access to the toilet. UN General Assembly also admitted this right on July 28, 2010. Target Seven C of the 7th MDG is related to the access of people to the facility of sanitation so that the process of the people’s defecation in the open is checked.

The call of Nature by Muhammad Atif SheikhFederal and provincial governments of Pakistan, with the help of international development organizations are trying to accomplish the fundamental right of the people and achieve the Millennium Development Goals. Due to all these efforts the instances of open defecation have been reduced. International institutes have also admitted that Pakistan has made remarkable progress in reducing open defecation rates. Report of the World Health Organization and UNICEF for Progress on Sanitation and Drinking Water Update 2014 clearly points to it.

“Pakistan stands at 7th position among the 10 countries that have achieved the highest reduction of open defecation since 1990, as a proportion of the population. In 1990, open defecation rate was 52 percent in Pakistan; it’s come down to 23 % in 2012. Reduction to practice of open defecation from 1990–2012 was 29%.”

Decline in open defecation rate in the country is due to the availability of toilets in houses. Various surveys indicate the number of houses deprived of toilets in Pakistan is gradually declining. According to the Fifth Census held in 1998, 51% household did not have toilets. This ratio has come down to 17%, according to Pakistan Social Living Standards Measurement Survey 2013-14. It means 83 percent household in Pakistan have toilets. In the same way, 70 percent household of Pakistani villages were deprived of toilets in 1998. Now this ratio has come down to 26 percent in 2013-14. Presently 74 percent household in rural areas has toilets. However, still to achieve the target of Millennium Development Goals 2015 to provide the people facility of sanitation much is to be done because Pakistan is yet far behind the target of providing sanitation facilities to 90 percent people according to Pakistan Millennium Development Goals Report 2013. The basic point of the target is providing access to improved sanitation (toilet) facilities, but their defective conditions are causing Pakistan loss of US$ 5.7 billion per year and 87 percent of this damage is borne by the health sector. Dr F.Y. Rabbani, a Public Health Specialist, is of the view that health promotion is the primary prevention and only way to reduce this loss and adoption of an improved sanitation facility (toilet) at home, developing consciousness about its proper use. She states,

“In many countries, such experiments have been conducted at the villages, wherein villagers have been provided with the constructed sanitary toilets and also given the training for proper use, as at many places people did know how to use sanitary toilets. People were not even aware of the use of flush system. Moreover, the difference in western and eastern commodes let to the difficulty for people as how to sit on them. When they were taught how to use these facilities, an evident reduction in burden of water, food and vector — borne diseases and the amount of monetary funds spent was observed. At domestic and household level, with single bread earner fellow in the house, expenditure will not be affected, and rather this will be useful and advantageous for economy both at micro and macro levels”.

The call of Nature by Muhammad Atif SheikhThe National Sanitation Policy was formulated in September 2006 to control sanitation problem in the country. It was formulated in the continuation of first South Asian Conference Declaration held in Dhaka in 2002 on Sanitation Policy to immaculate the atmosphere affected by open defecation. Moreover, in the proclamation of the Fifth South Asian Conference on Sanitation held in Kathmandu, Nepal, it was unanimously declared that South Asia will be immaculate from open defecation till 2023. Joint Monitoring Program of World Health Organization and the United Nations Children’s Fund (Unicef) set the target of Water Sanitation and hygiene after 2015. According to the target, if achieved, world will be made free of open defecation by 2025.

The Pakistan Poverty Alleviation Fund is active in all the districts of Pakistan to eradication of poverty’ and provides the basic necessities of life. PPAF with the cooperation of the World Bank is working on a plan to end open defecation in the villages of the country. Muhammad Nadeem, Senior General Manager Community Physical Infrastructure (PPAF) is of the view that “We signed an agreement with the World Bank about a year ago. According to the agreement, we selected 6 union councils of 6 districts to initiate ODF (open defecation) as a pilot project. In the six selected union councils, the work of completely free ODF was started. Presently, in six selected Union Councils we have made them 70 percent ODF free. In other words, we just developed awareness and the people constructed their toilets on a personal level. In future the next phase is expected next year. We intend to extend the program in villages of 121 districts with the partnership of our organization. The most beautiful aspect of our program is, I think, that we also provide technical guidance and provide financial support for this. We tell them how to save money. We tell them that they can save money by reducing their expenditure on useless things. In this way, they can construct a toilet in their house with the saving of aid. We monitor all the process technically and PPAF imparts technical assistance to those people for their training and improvement. People who eat betel-leaf and gutka, can save a small amount spent just two three months. We design a low-cost economical sanitation unit within the cost of Rs. 5 to 6 thousand. Our mandate is very broad. So far as your question about micro credit is concerned, yes, if somebody wants to construct a toilet in his house PPAF provides credit also. By the will of God, we hope that with the support of the World Bank and their financial assistance PPAF intends to work on a wider level in the future in 121 districts by raising awareness and providing technical guidance along with financial aid on ODF.”

The journey to end open defecation in the country and provide them access to toilets is still continued. The destination is not far away if attention is paid not only to provide toilets in all houses, but also to the public toilets out of the house at community level.

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