WaterAid on Dirt

Uttar Pradesh, India, 13 Feb. 2010: Savitri (age 30). Friedrich Stark, colour photograph, 2010
Uttar Pradesh, India, 13 Feb. 2010: Savitri (age 30). Friedrich Stark, colour photograph, 2010

Our Dirtexhibition has now closed, but the work of the artists and organisations involved in the battle for hygiene worldwide goes on. WaterAid is one such charity, and Natalie Coe accompanied two of its senior staff on a very special tour of the exhibition.

Our most recent ‘Perspective’ series of tours is all about offering a fresh and relevant point of view on ‘Dirt’, so what better experts to invite than Barbara Frost (CEO) and Ian Ross (Policy Analyst) from WaterAid, a charity that works with dirt to help improve lives in the world’s poorest communities. On Tuesday 9th August, they swapped their usual environments of sub-Saharan Africa, Asia and the Pacific for the immaculately clean museum world to talk about how their work relates to our exhibition, ‘Dirt’.

The tour began with Barbara and Ian’s proclamation of their passion for poo; reminding us that dirt is much more than just an interesting topic for an exhibition. They opened with the disarming facts that nearly 1 billion people worldwide have no access to clean water, and 40% of the world’s population does not have access to a toilet.  This might be surprising to those of us who live in London where sanitation is very much taken for granted, but this wasn’t always the case, as demonstrated at the first tour stop in the section on cholera in 19th century Soho. While we recoiled at the 1853 sample of cholera-infected intestinal secretion, Barbara pointed out that diarrhoeal diseases are still the biggest killer of children under the age of five today, despite contemporary understanding that it is spread through contaminated water, not ‘miasma’ (‘bad air’) as was thought in 19th century London. The trouble is, it’s not just a question of knowledge; cholera often co-exists with emergency situations or state collapse like in Haiti and Zimbabwe. WaterAid therefore focuses on the political big picture, not technical solutions alone. If this kind of advocacy work is successful and resources such as vaccinations and clean water are available, then no-one need die from cholera.

Sanitation is demonstrably central to public health and often cited as the most important development in medicine. We must also, therefore, think about the people who work in sanitation; the people who essentially stand between a city and disease. This applies to contemporary sewer workers, or ‘flushers’, as much as it does to the workers who built Bazalgette’s 1858 sewers that eradicated cholera from London. Barbara illustrated this by recounting her recent trip down into the beautiful Victorian sewers of Brighton. Indeed, her description left me very much wanting to go and meet some flushers in their ‘offices’ myself (for those who are equally tempted, you can book a sewer tour). If her account of the flushers unleashing a mechanical rat is anything to go by, working in a sewer does not drain a person of their sense of humour!

As much as Barbara seemed to have enjoyed her sewer visit, I’m sure she would have been pretty keen to wash her hands afterwards. The humble act of hand-washing was in fact the subject of the next exhibit on the tour: a video by artist Bruce Nauman. Barbara used this to reveal that hand washing is the most efficient and cost-effective cure in sanitation; it decreases diarrhoea related incidents by a surprising 45%. Teaching about hygiene and how diseases are transmitted is therefore vital to WaterAid’s approach; simply installing toilets is not enough. Why would someone go and use a tiny dark enclosed hut that everyone else defecates in when they could go outside in the fresh air? WaterAid learnt this the hard way, finding brand new toilets being used as storage when they went back to visit, so they now take a ‘community-led total sanitation approach’. This allows behaviour change to occur within the community. A great example of this is some local children taking it upon themselves to name and shame anyone who didn’t comply with the new toilet system. If they saw any misplaced ‘deposits’ they would go and put a flag in it labelled with whoever they suspected of being the perpetrator! This question of when and how to change behaviour is always a subject for great debate in public health, as relevant to non-infectious diseases in Britain as to hygiene practices elsewhere.

These social-cultural approaches are undoubtedly aided by our underlying emotional or intuitive responses to dirt, especially the dirt we produce ourselves. Surely, acknowledging this feeling of disgust that Mary Douglas talks about is an effective way of changing behaviour? Indeed, no-one wants to ingest someone else’s faeces (or their own, I imagine). WaterAid agree that it’s their job to help people make that link between their behaviour, the ‘yuck factor’ and the potential spread of disease.

So, encouraging hand washing is central to WaterAid’s work, but what about where this isn’t enough? What if it’s your job to work with faeces all day long? This is the case for some members of the Dalit caste in India, who work clearing human excrement from the technically outlawed dry public latrines. WaterAid’s priority here is to come up with innovative flush toilet designs and processing plants to eradicate the need for these dry latrines that require people to work in them. Sensibly, Barbara and Ian recognise that the most effective way of establishing new, efficient technology is to come up with ways that people can capitalise on human waste, for example producing biogas or selling it as fertiliser. Barbara had even heard a rumour that some researchers were looking at how we could use microwaves to transform faeces to gas.

This kind of innovative thinking is essential in preventing a lot of ‘dirt’ or sanitation issues. But, Barbara explained, this is relatively straightforward compared to ensuring that the local infrastructure and funding is there to support these developments. WaterAid works hard to override politicians’ instinctive preference for opening schools and hospitals over sewage works. This is all the more apparent when you realise that of all the UN Millennium Development Goals, sanitation is the most behind target.

The taboo of dirt, then, even extends to the politics of sanitation at national and international levels. One artist to symbolically transcend this taboo is Mierle Laderman Ukeles, the artist in residence at Fresh Kills, an ex-landfill site near New York that is soon to become a recreational leisure park. As Barbara highlighted by visiting the Brighton sewers, sanitation workers are vital in keeping our cities healthy but can sadly be subject to the same taboos as the ‘dirt’ they work so close to. Ukeles instead wanted to celebrate this ‘dirty’ work by shaking the hands of every single sanitation worker in New York.

The tour would have come to an end at this point were it not for the deluge of questions that Barbara and Ian’s discussion had prompted – a sure sign of any tour’s success. So it ended with some discussion on which corporations are interested in funding WaterAid’s work; from soap manufacturers to those with less obvious reasons, for example drinks manufacturers worried about water scarcity. We then heard a bit about how Barbara and Ian’s work might have influenced their own hygiene habits (increased hand-washing) before, finally, trying to guess what a ‘flying toilet’ might be. But I’ll leave you to work that one out for yourself.

The ‘Dirt’ series of Perspectives tours has now finished but there will be a new series of tours to accompany our next exhibition. Please keep an eye on our website for details.

Sanitation comes under the remit of one of Wellcome Trust’s five focus areas, ‘Connecting environment, nutrition and health’, which is involved in tackling poor sanitation in developing countries, the African Snows project and recent findings on cholera.

For a fantastic example of a fun and artistic way to engage with children about hand-washing, see Wellcome-funded artist Isobel Manning’s account of working with children in Great Ormond Street Hospital.

Natalie Coe is a Visitor Services Assistant at Wellcome Collection.

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