Inside the Hidden Dangers of Life Without Toilets

Photograph by Andrea Bruce, National Geographic
Without proper sanitation, good water is hard to find. Most villages receive their water from wells or lakes like this one, which is contaminated through open defecation in a village near Bhubaneswar, India.

When photographer Andrea Bruce arrives in a new place, she has a list of questions she asks herself which act as a barometer for how developed a country is: “What do their roads look like?” and “What do their daughters want to be when they grow up?” After a recent assignment for National Geographic magazine about the global problem of open defecation, Bruce added a new question to the list: “Do they have toilets?”

“You can really tell where a country’s priorities are just be seeing what bathrooms in public schools are like,” says Bruce.

A story on the problem of people defecating without toilets wasn’t the type of assignment she was ever expecting to get from National Geographic, but she soon realized that, in terms of global significance, this wasn’t unlike the conflict work she had done in the past.

After charities spent $28,000 to install a sewer line in Safeda Basti, 62 households constructed and connected private toilets, some of them on rooftops (bottom left). Without other plumbing, however, most residents must still haul water for flushing and handwashing from taps in the street.
Dhalu, a member of a low Hindu caste in the village of Peepli Kheera in India, sits in the courtyard of his home while a child defecates in the background.

Without proper sanitation, good water is hard to find. Most villages receive their water from wells or lakes like this one, which is contaminated from open defecation.

In a New Delhi slum, Sundar Kumar, 27, bathes from a well next to a garbage dump where people defecate in the open. Open defecation may happen more often in India's villages, but it has a deeper impact on the water supply in India's slums.

Early in the morning, residents of the Anna Nagar slum in New Delhi use water taps to fill up their buckets for their family's daily water needs. The taps are located beside the railroad tracks where people defecate.

Early in the morning, residents of the Anna Nagar slum in New Delhi use a space near the railroad tracks to use the bathroom.

In a game much like musical chairs, children from a nearby slum in India are taught how to use squat toilets correctly.
In the village of Peepli Kheera, population around 800 people, there is only one toilet which is kept under lock and key. The entire community defecates outside.
Tap images for captions

“It’s probably one of the most—if not the most—important topics for humans today,” she says.

Open defecation and lack of access to clean drinking water are the top reasons for child mortality in the world for children under five. It is also a leading cause of rape for women in India, where women in rural areas seeking a private place to relieve themselves go out into the fields alone very early in the morning or at night.

At a community toilet complex in Safeda Basti, one of Delhi’s many slums, women wait their turn for the single functioning latrine—while covering their noses against the smell of feces left by someone who couldn’t wait. Many people skip the hassle of city-run facilities altogether and do their business in rubble-strewn lots.

Photographing a story about poop has its own set of challenges for a photographer—finding the balance between complex and nuanced pictures that aren’t overly grotesque and showing simple beauty. But Bruce approached it the same way she does any story: “[I] get involved with people’s lives very intimately, and just follow them…you realized it’s about the shared human experience. So that is the bottom line.”

Bruce travelled to India, Haiti, and Vietnam, lugging around a large-format camera to make portraits of toilets and, as she says, to “show the daily life and similarities between people who live in this situation.”

Each country was grappling with its own set of obstacles and had made varying levels of progress when it came to solving the problem of open defecation.

In India, where Bruce spent the most time, there was a paradox between governmental action and inaction. The country has promised 100 million toilets to its residents by 2019. But promising a toilet is only part of the solution, says Bruce. “They also have to convince people that having a working toilet is important and tell them why” and get them to use it.

Indoor plumbing in newer schools has helped whittle Vietnam’s open-defecation rate from 39 percent in 1990 to almost zero today. Even young students, like this five-year-old in Ben Tre city, act as sanitation ambassadors, bringing home lessons on toilet use and handwashing to share with their families.
In much of Vietnam, the use of toilets is an improvement made in the past 10 years. Here, a mother brushes her daughter's teeth in the bathroom in their house in Ben Tre province, Vietnam.
In the southern village of Vinh Xuyen, Phham Thi Lan washes her son with pond water beside the family latrine, which drops nutrients into their fish farm. Recycling feces this way is an old practice that’s better than open defecation and can be done safely—but separating waste from drinking and bathing water is imperative.
Tap images for captions

Vietnam turned out to be a success story in terms of the issue but tough in terms of access. “People aren’t very open and they’re very suspicious of cameras…so you really have to spend a lot of time with them to get them to understand the story that we’re working on.” Nevertheless, once people did open their doors, Bruce was pleased with what she saw. “You could see the schools all have toilets, and open defecation doesn’t happen as much in Vietnam as it did 10 years ago.”

Perhaps the most challenging event to photograph for Bruce was in Haiti, where groups of Haitians share toilets which then need to be cleaned out by hand a couple of times a year. The people charged with this task are known as bayakou but Bruce refers to them as “the sanitation superheroes of Haiti.”

The bayakou work at night, when their identities were easier to conceal and the smell is less intense.

In Port-au-Prince, Exilien Cenat stands above the hole in a communal outhouse. Working at night to avoid public scorn, he empties the pit with his hands and a bucket, collects the waste in bags, and dumps the bags into ditches or canals. Flush toilets and sewers would be a more sanitary solution, but they’re simply too expensive.

“Everyone hates them and their identity is shielded from the public for the most part because they represent the problem that Haitians haven’t been able to figure out— how to take are of overflowing toilets in their backyards.”

It took three to four months for Bruce to convince one of the bayakou to take her with him. For five hours, Bruce photographed a man “immersed head-to-toe in sewage of different sorts, and his eyes would barely open by the end of it. They were just kind of swollen shut.”

Rose Dena, 85, attempts to clean what is left of her home in the mountains of southern Haiti more than a month after Hurricane Matthew made landfall in October 2016.
The river that runs through downtown Port-au-Prince reeks of sewage and trash due to bags of feces left in the river by bayakou who empty the latrines. During the rainy season the river overflows, bringing sewage and trash into the heavily populated neighborhood nearby.

Continual flooding in the slums of city Cap Haitian makes it difficult for residents to control the threat of cholera, causing reoccurring outbreaks. Many residents defecate openly in the alleys of the slum.

June Volontiaire's daughter brought her to a health clinic in Dame Marie to be treated for cholera. The disease is now heavily present throughout the south, rising and falling with the rain that carries infected sewage down the rivers.
It took Fritznel Xavier’s parents six hours to carry the vomiting teenager to the cholera treatment center in Jérémie. Stabilized with intravenous fluids, Fritznel survived but returned to a village that lacks adequate toilets. Cholera most frequently afflicts the young and the old. In Haiti it sickened tens of thousands in 2016.
Tap images for captions

When she first arrived to Haiti, she came prepared with all sorts of protective gear and clothing, but when it came time to work with the bayakou, she ditched everything she brought. “For me to sit there [in Haiti] and cover my face to shield from the smell [when photographing the baykou] would have shown them that I don’t respect or appreciate what they’re doing. I will do what they do, and I will not make it shameful.”

Toilets are sold on the streets of Port-au-Prince, Haiti. Most Haitians outside of the capital city practice open defecation. Flush toilets inside the city often cause problems because they use an excess of water and dump into pit latrine holes which often must be emptied by the hands of bayakou workers.

By the time her documentation reached an end, she acknowledged that the reason the problem could still exist on this scale is because it’s not something people want to think about. “It’s not something beautiful. It’s something people would rather forget is an issue, and that’s probably the biggest reason why it’s a problem all over the world.”

Andrea Bruce is a photographer for National Geographic. You can see more of her work on Instagram . 

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