Sounds like a status message in Facebook. But that should pretty much sum up the relationship between WASH strategies and nutrition outcomes. Obviously, when there is unsafe water, pitiable and inadequate sanitation conditions with woeful hygiene practices, it will inadvertently lead to public health implications. This is especially critical, when we talk about the imminent health hazards, in overtly crowded and densely populated spaces filled with undernourished urban poor population with low economic background.

The reason and outcome of poverty itself are mutually exclusive for undernourishment in the urban poor populations. In addition to that, undernourished people with poor health are obviously more prone and vulnerable to WASH related infections, such as fecally transmitted infections including but not limited to diarrhea, environmental enteropathy, nematode infections and other intestinal infections.

There is an active, nasty cycle of WASH related infections and undernutrition. For instance, an under nourished person who is recently infected by diarrhea due to poor WASH practices, will have lower stamina and strength left in his/her body, as their capacity to absorb nutrients will have reduced on their way to recovery. So in the context of the urban poor, the nutrients absorption rate or the capacity of the undernourished person to take advantage of the nutrient / calories intake is significantly reduced. With poor immunity, under nutrition and lack of access to good healthcare, they will be more susceptible to subsequent infections, and the cycle continues, adding to their cup of woes.

The impact of poor sanitation practices and the resulting diarrheal infections, on under nourished children is much worse. It has been proven to cause growth stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age), and even child deaths. The micronutrients deficiency (in terms of Vitamin A, B12, Riboflavin, Folic acid, Iron and Zinc) that is evident among children and also women, exacerbates their vulnerability to WASH related infections. I don’t want to sound like an emissary of Doomsday. But the other associated fallouts that dampen the functioning of the system besides malnutrition, stunting in children, premature deaths, are wasted time and loss of productivity.

So in order to achieve a universal and sustainable outcome, it is imperative that we start to think on the lines of linking and establishing synergies between WASH plans and policies with nutrition strategies. We need to work towards demonstrating and bringing in WASH interventions by coalescing with nutrition programmes.

The key priorities would be to reduce the high malnutrition rate, to address the micronutrient deficiency, improve quality, coverage and access to water, sanitation and hygiene services and practice, adopting nutrition sensitive sanitation and holistic WASH related interventions, to improve the overall health of the populations and well, the betterment of humanity. Pretty lofty and ambitious one might say. Easier said than done, right! But in this so called post-truth and self-awareness era, as the popular saying goes, to making it count, if we do our bit to instill a systematic progressive change in our midst then we just might make a positive difference in the world.

References used:

http://riceinstitute.org/wordpress/wp-content/uploads/downloads/2013/04/rice-sanitation-stunting-brief.pdf (accessed on Mar 28, 2017)

http://thousanddays.org/wp-content/uploads/The-Impact-of-Poor-Sanitation-on-Nutrition-1.pdf (accessed on Mar 28, 2017)

https://www.unicef.org/media/files/IntegratingWASHandNut_WHO_UNICEF_USAID_Nov2015.pdf (accessed on Mar 28, 2017)

Who built the Taj Mahal? Yes, that’s right. The masons built it.”

With this opening remark, the Masons’ Training Programme held at Coimbatore was kicked off.

I had the opportunity to join in on the Masons’ Training initiative conducted as a part of Capacity Building initiative in both Trichy and Coimbatore.

Now for a brief introduction to the training programme: the audience belonged to an age group ranging between those in their teens to those in their 60s. The average experience ranged from 20 to 30 years. About 35 attendees were present in each of the venues and the training programme was coordinated by IIHS, CDD and Gramalaya in Trichy and, IIHS, CDD and Keystone foundation in Coimbatore.

Why was a training programme needed for the masons? It has been found that in most households septic tanks are mere holding tanks built without any proper lining. And these are not desludged regularly which has led to groundwater contamination. The training programme was arranged to create awareness among the masons on the sanitation value chain and provide them with information on how to construct septic tanks and twin pits according to the Indian Standard Guidelines.

What did the masons learn? Though most masons seemed to know the dimensions of the septic tank to be constructed (for an average household of five people), particulars about twin pit construction and information about gas formation in septic tanks were new to them. The masons were also unaware of important details like the necessity and placement of vent pipes. This knowledge was imparted during the training.

What we can learn from the masons? There were masons with over 30 years of experience sitting very patiently listening to the training programme with great modesty and respect for the instructors. Many were brilliant organisers in addition to being builders. In Trichy we conducted a session where a septic tank and twin pit was actually built. The manner in which the masons cooperated with each other was notable. Most of them had no experience of working together yet they managed to divide the work amongst themselves efficiently and execute it. In another instance, during the Coimbatore training programme, the masons were given a task in which they had to make a bio-toilet model from hardboard cutouts. Bio-toilets are to be placed above the ground level with steps leading to the door. In the model that they were asked to build the door of the toilet opening outside. One of the masons pointed that if there are to be steps leading upwards to the door, the door has to open on the inside. The masons were aware of these small but important details in construction, which if ignored would lead to difficulties at a later date.

What I learnt from the training? Educated personnel, such as professional engineers, are ignorant of technical terms in native/regional languages, which are crucial in communicating with those on the ground especially if we are attempting to change their habits. I learned many of the commonly used engineering terms in the regional language during the training programme, including words for treatment, technology, advanced technology, septic tank, soak pit, twin pit, single pit etc. This was of considerable benefit and motivated me to find out the translations or the words used by masons in my native language as well.

Another lesson I learnt was one of wisdom that is acquired from experience. So for instance, it is one thing to know that if plastering is to be done, then the ratio of cement to sand is 1:6, (being a civil engineer I know this) then again the amount of water to be added is something I will require some time and effort to get right. But for the masons all of this comes naturally – without any effort at calculation. It is my belief that civil engineering students should spend at least a day with the masons to understand the difference between “textbook knowledge” and one gained through experience.

Was the mason’s training helpful to the masons? Though they were aware of the basics, many masons were deficient in their grasp of crucial details to be kept in mind during the construction of a septic tank or twin pit- regarding vent pipes, gas formation etc. Filling these gaps in their existing knowledge helped the masons a great deal. And when we see proper onsite sanitation systems being built in the households of Trichy and Coimbatore in the coming years, we will get a definitive answer on how useful the training was.

So, you have finished using the toilet. And, have flushed it down. But seriously, where does it all go?

When you ask this question, the answers you get will range from septic tanks to pits to the underground sewerage systems etc. But, is that the whole story? Now that is the difficult question, which begs a real hard look at the ground reality.

Let’s travel some years back in history. It is a well-known fact that ancient India had a fine network of storm water drains, which acted both as groundwater recharge systems, as well as flood control devices. In cities like Chennai, the network of storm water drains led to ponds (kulams) which acted as natural flood control devices. Thanks to unbridled ‘development’ and growth of unplanned settlements both these ‘kulams’ and the storm water drains are polluted and choked.

How have things come to this state? One of the major contributors of pollution in storm water drains (SWDs) are the people themselves. This happens in three ways: Many of the households, which have no containment structures attached to their toilets, connect the toilets to the storm water drains. Sometimes, even households, which have containment structures, connect the outlets the storm water drains. Thirdly, it is not unusual to see that the grey water from the kitchen and bathroom being connected to the storm water drain directly.

A study conducted by Tamil Nadu Urban Sanitation Support Programme (TNUSSP) on the state of the storm water drains showed that this kind of pollution was not only common in small towns but also in mega cities. When asked why toilets and containment structures were connected to storm water drains, most of the residents said that they used the storm water drains as an easy option because it was the “common practice in the area.” Some of them also mentioned the “lack of other options” as one of the reasons.

Letting grey water from the kitchen and bathroom into the open or closed drains is a very common practice all over the country. This is also because many of the people believe that storm water drains are meant to carry the grey water. It comes as a surprise to many people when they learn that storm water drains are meant only to carry storm water and urban runoff (surface runoff of rainwater) to the natural water bodies. However, in reality, the storm water drains end up carrying all the wastewater from the cities (and towns) to the natural water bodies resulting in the grand scale pollution of the water bodies and leading to a colossal public health hazard.

How does dumping of solid waste affect drains?
Dumping of solid waste in the drains is another huge problem that affects the functioning of the drain itself. The drains are designed based on certain set of criteria like the amount of rainfall in the area, natural slope and type of soil etc., which helps to estimates the amount of storm water that will get collected in a particular area. Dumping of solid waste and wastewater into the drains affect their functioning, resulting in improper flow, siltation and stagnation of water which further leads to a whole range of problems like bad odour and serving as a breeding ground for diseases like malaria, dengue, etc.

Where does it end up?
The final destination for the wastewater, which is carried by the drains are the natural water bodies such as streams, rivers, canals etc. A research into how these waterbodies have transformed over a period of time into gutters carrying dirty water will help us understand how we are killing them slowly. Not very long ago, people used to stop to look down bridges to enjoy the scenic beauty of clean, flowing water. Today, they cover their noses and try to get away as soon as possible.

To understand this problem better, the TNUSSP team conducted catchment level assessment of drains in selected locations. Watch this space for further insights into the study.

For Further Reference:

(http://www.downtoearth.org.in/news/what-drains-mean-to-cities-44069, 2014)

Working in sanitation throws up many interesting possibilities and questions. One such question was about the ‘hidden taskforce’ of septage management – the desluding workers – who work behind the scene, who are hardly acknowledged, but who are the prime players in septage management. Theoretically, we know that unless the collected septage is carefully desludged and safely transported from the containment structures to the treatment plant, no amount of securing the rest of the links in the sanitation chain would ensure safe sanitation. However, we barely interact with the desludging operators and know far less about their work on a day-to-day basis.

With dry toilets being declared illegal, and more and more houses moving towards toilets with septic tanks, a set of budding entrepreneurs are appearing in the market with their vacuum trucks known as honeysuckers to empty the septic tanks for a small fee. We also read regular articles in the media about illegal dumping of septage into water sources and open grounds, which creates a huge health as well as environmental hazard.

Given all this myriad information, we decided to find out more. So one fine morning, my colleague Suresh and I decided to get on to a desludging truck and find out what one day in the life of a desluding operator looked like. We got on to a desludging truck….

Before he turns in the ignition key, let me introduce you to Kumar, our lorry driver. A resident of Sathyamangalam, Kumar travels around 70 kms each day to reach his workplace in Coimbatore. Around 8:30 am, each morning, Kumar teams up with another one or two people and sets out on that day’s business. Today, he has one assistant, Muthu with him, but since the two of us are also around, he has asked Muthu to go and sit on top of the vacuum tank, while the two of us take our place next to the driver. Once we are comfortable, Kumar informs us that we are going to a poultry farm near Kaattampatti for the first desludging operation of the day.

Two hours along the Pollachi Highway brings us to Kaattampatti. We make our way to one of the largest poultry farms in the district. As soon as we enter the premises, a couple of workers come our way with cans of phenyl, which they pour on the lorry to disinfect it. The ease with which the entire exercise is carried out makes us realise that the farm is among Kumar’s regular clients. After the ‘disinfecting’, the lorry proceeds to the place where the septic tanks are situated.

Once the ignition is switched off, we watch in amazement at Kumar’s metamorphosis. He is no longer the chatty person who was sitting beside us behind the wheel. He jumps down from the driver’s cabin, reaches the septic tank and breaks open the sealed manhole with a crowbar. In an equally well-coordinated move, Muthu pulls down the extension hose from the top of the truck, connects it to the valve embedded on the tanker, and pushes the other end into the septic tank. Thanks to the vacuum suction technology, the vacuum tank is filled with 5000 litres of septage in a few minutes. Throughout the entire process, Kumar has kept a careful watch on the volume gauge mounted on the tanker.

While this entire exercise is taking place, Suresh and I introduce ourselves to the staff of the poultry farm. After some initial hesitation, some of the workers began speaking to us. We get to know that close to 90 workers work and live on the poultry farm. They share common sanitary facilities, which are spread around the farm, and on an average around 15 lorry loads of septage was being generated by the farm every month. Our jaws drop on hearing this number. “Where do they take so much septage? What is the disposal mechanism,” was the question on our minds. We keep a straight face and ask Kumar where the nearest dumping location was. “Oh, I have an arrangement with the nearby farmland,’’ he says confidently. “We will go there in a while,” he adds.

Surely enough, half an hour later we are at a large coconut grove. With the farmer’s wife supervising the unloading, Kumar and Muthu empty the entire tanker into the groove. We take the opportunity to speak to the farmer’s wife. She tells us that her farm receives around 20 loads of septage every couple of months. “It is not only from the poultry farm, we have an arrangement with a couple of other places for regular supply of septage,” she says with a smile. Her husband who had joined her tells us that the septage is very important during dry spells when the farm faces acute water scarcity.

Soon it is time for lunch. The owners of the farm invite Suresh and me to join them for lunch. Kumar and Muthu have brought their lunch along with them. They go to a nearby tap and begin washing up. I watch as Muthu fumbles around in the driver’s cabin and pulls out a used detergent soap wrapped in a newspaper, which he and Kumar use to clean their hands and feet. The sight is a kind of relief for us, as we had observed the two carry the hosepipe from one septic tank to another on their shoulder, wiping the spillage with their bare hands!

Once lunch is done, the work continues. Kumar and Muthu take turns building mud bunds around the coconut trees, with their bare hands, to prevent spillage and overflow. The farm owners’ small children continued to play in the vicinity. One toddler keeps coming to Kumar and Muthu and the duo keep embracing him, carrying him, playing with him throughout the time they are working.

It is late in the evening, when the work is done. It is time to head home. On our way back, we find out that both Kumar and Muthu had dropped out of school and taken up this profession. Kumar earns close to Rs 17,000/- per month, while Muthu earns Rs 12,000/- .
As we near Coimbatore, we stop at a roadside teashop. “Take that smelly truck away,” someone shouts from inside. We look at Kumar. He has a defiant look on his face, but his voice trembles as he says, “There is no point in getting into a brawl. This is our profession and we are proud of it.

Fecal Sludge Management (FSM) is a management system that safely collects, transports, and treats fecal sludge (also called septage) from pit latrines, septic tanks or other onsite sanitation facilities (OSSF). One of the key components of fecal sludge management is the safe transportation of fecal sludge from the onsite sanitation facility to the point of treatment. There is no doubt that safe disposal of fecal sludge is the primary objective of any FSM project, and the fecal sludge transporters play a key role in this process.

In fecal sludge transportation, different stakeholders are involved in the successful transfer of sludge from containment to the treatment facility. These stakeholders include households, service providers, sanitary workers, septage truck owners and officers from the Urban Local Body (ULB). However, it is commonly seen that these different stakeholders do not work in a co-ordinated fashion when it comes to transporting fecal sludge from households to a treatment facility. It is in this case that technology can come to the rescue.

At present, the existing system is not fully equipped for holding, retrieving and maintaining information on sanitation facilities including service provision. For example, no authorised body in the ULB has complete information on Households (HHs) sanitation facility, fecal sludge containment and fecal sludge flow. This lack of information and communication will, in the long run, account for badly managed sanitation systems. In this scenario, it would be interesting if fecal sludge transportation followed a system like Uber or Ola cabs using an application.

Let us examine this idea a little more closely. What do the residents want from any service? 1. Reliability, 2. Efficiency 3. Cost effectiveness. All these three are available in the Uber and Ola Apps. These transport services are using mobile web-based GIS technology to provide real-time information about the vehicle, vehicle number, contact number and approximate cost (based on travel distance, total travel time and base fare). Once the service is complete, the customer is asked to rate the service for efficiency.

While this system can be easily adopted by the ULBs to reach customer locations as well as keep track of the septage trucks, the ULBs are wary about its misuse because once the mobile has been turned off or the app has been uninstalled, it is difficult to track the vehicle. However, if we keep in mind that the core aim is to provide customers with better services, and not just prevent illegal dumping of fecal sludge, these small lapses can be set right.

FSM projects in countries like Senegal have established the world’s first innovative call centre system to enable the customer to receive the best and most economical service for desludging. This system operates on request-based desludging not schedule-based desludging. The clients send their request for desludging to the call center, and the call center contacts the operators near the said client’s location for quotations. The call center, then sends the lowest quotation to the client based on which the client asks the call center to send a particular desluding vehicle. Once the desludging is completed, the call centre calls the client to check for customer satisfaction. This system works well, but requires transparency at all levels to be sustainable in the long run.

The integration of GPS, GIS, GPRS and the mobile-based web application for Urban Local Body, service providers and residents will improve the quality of service, are easy to monitor and ensure safe environment. GPS will provide the current position, GIS will provide route directions and how to get there (simple algorithm for path finding using different aspects shortest path, regulated path and travel time), while GPRS will provide real time data, through the mobile towers.

If the FSM project needs to be successful, it should follow the improved service orientation approach not just monitoring approach. If the sludge transport system has to run successfully for long periods, the process has to be transparent, and it should benefit both clients, as well as the service providers. Towards this end, all stakeholders have to sit together and discuss the possibility of an improved service-oriented approach to create a better environment for everyone to live in, and this approach should be facilitated by the Urban Local Bodies.