By Zofeen Ebrahim
KARACHI, Pakistan, Oct 2 (Asia Water Wire) - "Since we started using the toilet, we cannot even think of life without one now," says 70-year old Qasim Jan, grandmother of 10.
She, along with 17 family members that include her husband, three sons and their wives and their grandchildren, use the one emergency toilet that was built by Catholic Relief Services (CRS) soon after the massive earthquake that shook parts of Pakistan a year ago.
Qasim Jan lives in the beautiful mountainous village of Bari Bandi in Siran Valley in Pakistan's North West Frontier Province (NWFP). On Oct. 8, 2005, a catastrophic temblor measuring 7.6 on the Richter scale flattened parts of the NWFP and Pakistan administered- Kashmir, killing over 73,000 people and leaving 3.5 million survivors homeless.
Jan narrates an incident before the quake. "One night, it was pouring and my eighty-year-old husband went to relieve himself. When he didn't return even after half an hour I got worried and sent my son after him. He found him lying in a ditch. He had fallen off the edge and three of his ribs were fractured."
Sitting by her side, her 10-year-old granddaughter Jamila, pitches in: "Because now we use toilets, in schools our teachers tell us how to keep ourselves clean, to wash our hands after using the toilet." Jamila says she's getting used to defecating indoors now, but her three-year old brother refuses to. "He screams and says he will fall in the pit," she laughs.
CRS, a partner organisation of the Catholic Agency for Overseas Development (CAFOD), provided over 1,800 emergency toilets - 'VIP' latrines as they are known -- to 80 villages in the emergency phase after the quake. They also trained a team of master trainers, including carpenters and masons, so that the community can carry on the work themselves.
"We provided them with ready-to-use toilets. But it does not end there. We have to ensure that they help themselves," says Ejaz Sikander, programme manager with CRS. To that end, CRS is asking the community to meet 15 percent of the cost (in kind usually) and to participate in formulating, mobilising resources and skills and implementing this project so that there is greater ownership of it.
SPREADING THE WORD
Before people began using toilets, women motivators from among them were asked to go from door-to-door and deliver, including in their own language, simple and precise health messages about hygiene, the use of toilets and how to keep them squeaky clean.
Thirty-eight year old Aurangzeb's family, from the same village as Jan's, had never used a toilet before either. "CRS provides us with material and trained us in construction of these latrines. I'm happy as it has not only provided relief for the women but also the elderly and the invalid."
He will build a new one when their previous ones fill up, he says. He has also purchased toiletries when the ones provided by CRS ran out "But most people here are so poor they cannot even feed their families properly. In such a situation, sanitation and hygiene practices are obviously not going to be a priority."
Asked why this was considered a need in an emergency for a community that had been used to open defecation, Ijaz Sikandar says: "This was a good opportunity to sensitise the community and bring about a longer-term change in hygiene practices. It will happen, but it's a gradual and slow process."
According to U.N. estimates right after the emergency relief phase, there was a need for 200,000 toilets for an estimated 4 million people who would otherwise be defecating in the open.
For some, the change toward better hygiene practices has already come about. Twenty-year old Mohammad Gulzar's pit toilet was damaged during the recent torrential flood caused by monsoon rains. Though money is a constraint, he is determined to construct another one as it has now become a necessity.
But for some elderly people, like Auranzeb's grandmother, the change is uncomfortable. "I am a bit scared of squatting across an open pit. And sitting in an enclosed place that stinks causes nausea," she adds.
Looking back, Sikandar says: "With so many people living in such close proximity, there was danger of outbreak of communicable diseases, especially cholera, which is usually the result of open defecation."
"Personal hygiene or even health awareness among the people is very poor here," says Asma Bano, a staff nurse working with Caritas. Scabies had reached an epidemic level just after diarrhoea and gastroenteritis had been brought under control. "It (scabies) has been contained now, although not completely and the NGOs have to keep an eye on it, visit the families, see to their dwellings from inside, or these people will go back to living the way they are used to."
"These people have always lived like this way, alongside the animals. The women were always malnourished and anaemic and they never had toilets in their homes, explains Dr Jawed Ali Khwaja, programme manager for health in Caritas, a Catholic organisation working in emergencies. "But what they must realise now is that they have been given a new lease of life, and of better quality, with so much work being carried out for their water and sanitation. So far, epidemics of waterborne and other communicable diseases have been averted. It must stay thus; otherwise another emergency will be at hand."
Along with toilets, CRS also constructed washrooms given the practice among villagers to bathe in the open. "Most children contract serious respiratory tract infections like pneumonia like this and given that they are poorly nourished, are quite susceptible to catching RTIs (respiratory tract infections)," adds Sikander.
With so many people using it, the pit toilet is fast getting filled. "But we'll dig up another pit and shift the material there," says Jan.
For women, she says, having a proper toilet has been a godsend. "Our privacy is insured now," Jan said, explaining that village women had to find a suitable place among the bushes to defecate, or wait till it was dark to relieve themselves. "Our backyard is not so filthy, nor does it stink. This means less embarrassment as well as decrease in diseases," the septuagenarian says knowingly.
A year on, Sikander and his team assessed the impact of the emergency latrines they had made in the villages and were staggered by the impact these have made. "With most pits filled, the villagers now want us to build pour flush ones."
CRS decided to build the 2,750 pour-flush toilets for communities that were not given the VIP latrines during the emergency phase. Sikander also says they are trying to modify the toilet designs so that the cost of building them can be halved.
CRS also repaired the destroyed water supply schemes, constructed new ones for the community and provided them with fibreglass water tanks with a capacity to store 1,000 litres.
"The earthquake destroyed the drinking water streams, some disappeared and new courses came up. After shelter, the second most fervent demand was repair of water, more than sanitation even," explains Sikander. He says the water quality in Siran Valley is still not as bad, but what is important is the management of the water that is available and how to bring it to the community.
The U.N. Children's Fund (UNICEF) has taken the lead in water and sanitation in the quake-hit areas. Terje Thodessen, the agency's principal emergency officer, says the goal is to minimise the risk of waterborne and sanitation-related diseases.
In the entire disaster zone, more than 80 projects have so far been completed. Up to 1,000 are planned for completion over the next two years.
UNICEF has helped build 35,000 latrines serving around 695,000 people and distributed 160,000 hygiene kits. It also aims to provide safe water to 1.5 million people and improved hygiene for 900,000 people, and has supported the repair of 195 rural water supply systems in 115 villages. (END/IPSAP/AWW/031006)