Dear John


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November 19 is one of the only unsung days of the year Hallmark hasn’t yet exploited: World Toilet Day. We spend about three years of our lives sitting on a toilet. Though we in the Western world may not realize it, that white piece of flushable porcelain is one of man’s best friends. We sit on its haunches morning, noon, and night, usually between six and eight times a day. It’s there for us after six-packs of beer, dried prunes, and bad Mexican food; through late nights and parties, bouts of nervousness and morning sickness; in sickness and in health. A good American Standard rarely lets us down and when it does, we just yank its chain and it dutifully begins to work again. These bad boys put up with our shit and rarely complain.

But some 2.6 billion people, including 980 million children, do not have this luxury, which is one of the reasons why the United Nations declared 2008 the International Year of Sanitation. Almost 40 percent of the Earth’s population does not have access to adequate sanitation, neither basic toilets nor hygiene facilities, according to the latest U.N. Development Program statistics. And what does this all mean? A lot of death, a lot of sickness, a lot of lost dignity, and millions of tourist dollars unearned. One child dies every 15 seconds from water-born disease. More than 400 million schooldays are lost worldwide every year because of diarrheal diseases. Mothers die in childbirth, menstruating girls skip school because of poor facilities, and the threat of rape increases as women look for places to relieve themselves in dignity at night. It’s these facts — along with a picture of Joe the Plumber — that got me listening to what a petite man with glasses and slightly graying hair had to say on the day Americans were lining up at the voting booths.

“Today is Election Day in America. We’re really excited about the possible outcome, but right now we’re going to talk about toilets.” And so began Jack Sim’s opening speech at the World Toilet Summit & Expo held earlier this month in Macau, a former Portuguese colony an hour by ferry from Hong Kong. I reached for a peppermint Mentos in the glass dish in front of me. “AIDS is sexy, toilets are not. There are 500 million toilets needed for the 2.6 billion toiletless people. As you bring people from poverty to health, they become more economically productive. There’s potential for $1 trillion in the global BOP [bottom of the pyramid] sanitation industry.” He changes the slide and up pops a picture of garbage wrapped in a Louis Vuitton garbage bag. “We need to make toilets an object of desire.”

Named this year as one of Time magazine’s “Heroes of the Environment,” Jack Sim is the man behind the lesser-known WTO, the World Toilet Organization, a non-profit based in Singapore dedicated to improving toilet and sanitation conditions around the globe, eliminating the toilet taboo, and developing a market-based strategy to install infrastructure. What began in 2001 with 15 member organizations now has 151 in 53 nations. His weapons? Humor, facts, grassroots organizing, and simple business practices. “Empower local women and you won’t need billions of donor dollars,” he preaches.

This year’s summit was held at the Venetian Macau Resort Hotel, an interesting choice considering that the purpose of the World Toilet Organization is to help the developing world. Summits in prior years have been held in, among other cities, Beijing, Moscow, Taipei, and New Delhi, which makes the most sense since only 30 percent of India’s wastewater is treated and open defecation is still widespread. But Macau? Macau is Asia’s Las Vegas. In 2006, gambling revenues from Macau’s casinos were for the first time greater than those of the Las Vegas strip, making it the highest-volume gambling center in the world. The Venetian Macao, which is modeled after its counterpart in Las Vegas, is the third largest building in the world. We’re talking 3,000 suites, 3,400 slot machines, 800 gaming tables, 1.6 million square feet of retail space, enough Renaissance-style faux painted walls to make Michelangelo turn in his grave, and a helluva fleet of toilets to maintain for people dropping a lot of money on odds stacked against them.

Both access to public toilets and clean sanitation facilities, however, are integral to promoting tourism, says Raymond Tam Vai Man, chairman of Macau’s Administration Committee. No one wants to watch where they step, and they don’t have to in Macau. The island saw 27 million tourists last year alone, up 22 percent from the previous year. Simultaneously, the number of public toilets has increased from 32 to 56. By comparison, tourism lost due to a perception of poor sanitation infrastructure in Nepal amounts to $5.7 million annually, according to the World Bank’s Water and Sanitation Program; that figure jumps to $238 million in India.

But in general, the presence of public toilets is becoming increasingly rare — and in Japan, home of the renown and fully kitted TOTO toilet, the consequences of so few public toilets could mean death on a massive scale. The nation’s disaster prevention panel released a study last month reporting that nearly a million people would be unable to find a toilet if a magnitude 7.3-quake struck Tokyo at noon on a workday, sending 12 million people pouring out of office buildings and creating a potential hygiene and sanitation nightmare of biblical proportions.

In London, almost half of the city’s public toilets have closed in the last eight years, and nationwide, the numbers of public toilets have decreased by 40 percent, according to British journalist Rose George, author of The Big Necessity: Adventures in the World of Human Waste. She also nods to a passage in a 2001 Fodor’s guide to New York City that mentions public bathrooms are hard to find and vary widely when it comes to cleanliness. Coincidentally, a husband-and-wife team in New York started last year, a Web site that combines Google Maps with detailed, user-generated content chronicling toilets and restrooms around the globe (but especially in Gotham) where you can deposit your gift via sitting (clean, safe) or squatting (filthy, don’t-put-your-butt-there).

“People are buying far more coffee and muffins than they need to just to use a restroom,” says George. “But you don’t get any protest about that, you don’t get anyone writing to their local congressman or MP. There isn’t this groundswell of protest and dissatisfaction with the status quo that you would need to get some kind of change at the top level.”

Dr. Kamal Kal, a pioneer in community-led total sanitation, a grassroots approach towards eliminating open defecation, is the last person to speak before our lunch break and subsequent tour of the expo. He’s worked in India, Bangladesh, Pakistan, Cambodia, Ethiopia, and Sierra Leone, among other countries. “How many of you have ever defecated outside?” he asks. We look around at one other — there are at least 150 people in the room. Nearly everyone raises their hand, slowly at first, then about level with their ear. Kal changes the slide to a picture of a slum in Calcutta that looks more like a storage unit for supplies and animals. “These toilets are used for everything except feces,” he tells us. “No human wants to live among shit.”

Improved sanitation means more jobs, more economic growth, and less poverty. According to a recent WHO study, every dollar spent improving sanitation generates an average economic benefit of $9. The “sanitary revolution” — that is, the introduction of clean water and sewage disposal — has been the greatest medical advance of the last century and a half, according to a poll by the British Medical Journal. Though vaccinations certainly helped curb the spread of disease, they didn’t altogether stop it as much as the toilet did. A simple toilet is one of the cheapest medicines, adding decades to the human lifespan — when it’s used.

We can thank the English for the first flush toilet, which was invented in the late 1500s just as the urban population was beginning to explode. Sir John Harington designed the modern-day precursor for his godmother, Queen Elizabeth I, and then a man named Thomas Crapper improved upon its various parts and commercialized it. The S-bend, which among other design principles creates a water seal that enables the bowl to remain filled, is still today’s standard design.

It’s not often we think about what happens every time we flush the toilet, and this “flush and forget” attitude is something we need to address, says WTO founder Sim. We see our solids and liquids disappear down the drain and off they go — but to where? In London it disappears into a network of sewers at least 37,000 miles long (by comparison, New York’s network is 6,000 miles and Paris’ 1,500) that extends 80 miles outside of Central London and eventually ends up in a wastewater treatment plant where it will be filtered and eventually cleaned and separated into effluent or sludge, which in the U.S. and the U.K. is primarily used as fertilizer.

However, wastewater treatment plants are not found everywhere. Vancouver doesn’t have one, so the sewage ends up in the sound. Brussels, administrative head of the European Union, didn’t have one until 2003, and Milan not until 2005. And even if a plant does exist, it’s often relying on infrastructure created a century ago for a much smaller population. “You just start to look at the system and you see it’s not as perfect as one assumes it is because we have this wonderful luxury of flushing the toilet and just seeing it disappear,” says journalist George.

It’s in developing world, however — the areas where Jack Sim and Dr. Kamal Kal have logged the most hours — that are ahead of the curve. Almost 40 eco-toilets have been installed at the Kalungu Girls Boarding School in Uganda, which consist of a toilet pit dug in the ground in two sections: one for urine and another for feces. Urine is collected in a septic tank while feces and toilet paper go into a basket. The user covers this with ash and every few days the waste is emptied into a drying chamber. Six to eight months later, it’s ready for use as fertilizer on the school’s nearby banana plantation.

And while Ugandan girls are busy fertilizing their banana trees, thousands of miles away in India more than one million Sulabh twin pit composting toilets, which turn feces into fertilizer over a period of about two years, are in use in more than 1,000 towns in 25 states. In China, more than 15 million rural households are connecting their toilets to a biogas digester, which transforms waste into fuel within a few hours.

“The most significant thing about sanitation at the moment is that psychology is changing and the mindset is changing, so instead of wholesale giving someone a sewer and a flush toilet, development people are saying, ‘Well, no, let’s adapt to what your cultural preferences are towards hygiene and latrines, and all your water situations, or your ability to pay or train your staff,’” says George. “All those things have to be taken into consideration. You can’t just install sewers willy nilly.”

At the expo, Ernest Koh, an instructor at Ngee Ann Polytechnic in Singapore, takes cultural adaptation seriously. He steps up on a prototype of a 2-in-1 Sit-Squat toilet designed by one of his students like it’s a kitchen stool. He straddles its wide-mouthed rim and proceeds to demonstrate the Southeast Asian squat position that faces away from the wall. “This position is good because it allows for a wet landing — so no splashing.”

He continues. “Squatting is healthier and more ergonomic. The angle between the anus and the rectum is increased, which means a smoother exit of stools. But if you’re disabled, or wearing tight jeans or pantyhose, it could be difficult. Which is why we also designed this to have a lid that pulls down so you can sit or squat.”

He proceeds to turn around toward the wall and demonstrates the East Asian method of squatting, most often practiced in Japan and Korea, different only in the direction the person faces. Then he stands up, puts the seat down, and sits. “The beauty of this toilet is that it caters to everyone. Many Asians find it more comfortable to squat and in many rural communities many people still do, but we want Western visitors to also be welcome.”

Koh’s booth is one of almost 30 featured at the expo, which is kind of the Sundance of the toilet and sanitation world without the red carpet. Sandwiched around his piece of expo real estate are booths hawking the latest in plumbing, pipe fittings, and porto-potties. But also featured is the waterless GottaGoToilet ($56) made from a cardboard box that apparently holds up to 275 pounds (I didn’t test it) that comes with a hole, eight biodegradable plastic bags, and magic powder that makes waste eco-friendly in a matter of days.

In the booth adjacent to the GottaGo is a new super toilet from Huida ($1,200), a Chinese company, that comes replete with an in-seat butt warmer, male and female water jets, an in-bowl light, and a USB port to hook up your mp3 while you do your business. Wang Yanqing, the company representative, also mentioned that there’s a model in the works with a hook-up for video games. “Huh, video games?” asked a man standing next to me. “Is this in response to consumer demand?” Yanqing responded by giving both of us a free towel.

In the back corner is a shoebox-sized model of the WC Tronic 402, a new concept of a public toilet made by Ströer, a German company that designs street furniture, or in their words, “out of home media.” This self-contained public toilet system is equipped with two toilets and is eerily automatic in every way, right down to the entrance door. When a person uses one toilet, the bowl, seat, and back wall of the other toilet fold into a hidden area for a deep cleaning and drying, all within the span of a minute or so. In other words, you’re sitting on a freshly cleaned toilet every time you enter — no need to layer the seat in one-ply toilet paper barrier to protect your bum from what lies beneath. The prototype is currently being used and tested in Dresden.

George hasn’t seen the model in person, but after hearing a description proclaimed, “Why would anyone use this if we can’t even master something basic!” Part of the larger sanitation problem, she adds, is simply a question of semantics. There’s really no neutral word in the English language for our waste. Excrement sounds too scientific. Feces too filthy. Shit too crass. Poop too elementary.

“It wasn’t always this way,” she says. “Two hundred, 300 years ago, you could attend the king on his toilet and it was considered an honor. We have this linguistic handicap that has fortified a taboo around the subject and it’s just impeding all sorts of development all over the world.” • 17 November 2008