Of Poo, Bugs and Super Drugs: World Toilet Day and World Antimicrobial Week 2023

Are you thinking, “Oh no, another arbitrary international day and week!

Who gives a crap!”? Urine for a surprise, and you should give a crap. This problem is huge, and it won't just flush away. 

As many as 3.5 billion people out there globally still living without safe toilets. 419 million people still practise ‘open defecation’. Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity. And it's up to each and every one of us to do something about it. 

It is important to take toilets, sanitation, and hygiene management seriously to understand that there’s more to them than meets the eye. There are multilayered cultural, historical, political and societal undertones that define a community or region’s toilet etiquette and waste-management practices. Many of us take clean, swanky and hi-tech bathrooms and toilets for granted today, but the picture around the globe is very different. Public health depends on toilets, as do improvements in gender equality, education, economics and the environment.

And who better to share in-depth perspectives on WCs, waste management and public health than CHL’s Assa Doron, Professor of Anthropology and South Asian Studies? The foundations of his work on waste management are based on the premise that politics, power and poop are deeply connected. Much of his anthropological fieldwork was conducted in Varanasi, India, where he focused on the ritual economy of the river Ganga and the extreme pollution that plagues the sacred river, detailed in his book, Life on the Ganga (Cambridge, 2013). Assa’s continued interest in environmental concerns led to a co-authored, award-winning book with Robin Jeffrey, Waste of a Nation: Garbage and Growth in India (Harvard, 2018).


India’s Sanitation Story

In 2015, an estimated 600 million people in India alone practised 'open defecation'. Professor Doron has researched and spoken extensively about the much talked-about Swachh Bharat—the Clean India campaign–launched by India’s Prime Minister Narendra Modi in 2014. Hundreds of millions of dollars have been poured into the Clean India enterprise, including a vast toilet-building program to eliminate open defecation. The campaign’s rural website shows over 85 million rural toilets built in the past four years, with the number clocking up every minute. In urban areas, the ticker shows construction of close to 5 million household toilets and 400,000 community toilets. Yet India’s towns and cities harbour a darker sanitation story. In scores of small towns, thousands of latrines are still cleaned by hand—faeces scraped from floors and tipped into wicker baskets usually carried on the heads of low-caste women (knowns as manual scavengers) and dumped untreated in drains or convenient waterbodies. This is despite the fact that manual scavenging has been illegal since 1993.

According to Professor Doron, technological solutions alone are not sufficient to resolve India’s toilet troubles. The primary factor jeopardising the success of the Clean India campaign—rarely speaks its name. It is caste–the belief, still widely held, that certain people are born to do society’s dirty work. These people, formerly referred to as “untouchables”, have been receivers, removers and transmitters of “pollution”, ritual and real, for hundreds of years.

India’s relationship with waste has markedly changed over the years. The practices of frugality and husbanding that were once widespread in a largely rural society have been replaced by a people enthusiastically embracing consumerism and throwaway culture, especially as population shifts to cities and towns. In the wake of the economic reforms of the early 1990s, the magnitude and composition of waste in India has changed dramatically. The population is more than 1.3 billion people—densely populated, with nearly 40% living in urban areas. The challenges extend far beyond consumer waste, as building and infrastructure projects were producing enormous amounts of waste from construction and demolition debris, along with new volumes of waste from mines, factories, and agricultural industries. Growing demands for water increase the difficulties of managing sewage and run-off.

Most recently, in the wake of COVID-19, open dumpsites and landfills have been filling up with tons of contaminated biomedical waste, which is left untreated. This poses a huge risk to those poor living and working near dumpsites, many of whom are waste pickers and scavengers, with little recourse to protective gear. The infection cycle is perpetuated, disproportionately affecting the poor and reinforcing enduring stereotypes about pollution and filth.


Antimicrobial Awareness

World Toilet Day coincidentally happens to fall within the annually observed Antimicrobial Awareness Week (19–24 November). The two are intrinsically connected, argues Doron, and given that we are in the throes of a pandemic-defined era, waste management is becoming increasingly critical to public health. Professor Doron’s research also delves into the aspect of antimicrobial resistance. His work uncovers the excessive use of antibiotics in India in human and livestock industry, along with an unregulated drug manufacturing industry. When we spoke, he explained further:

“In South India for instance, there are antibiotic manufacturing plants that routinely spew out untreated effluents contaminating waterways with toxic pharmaceutical residues. This creates a setting especially suited for the strongest and most dangerous bacteria to survive—what we often call Superbugs. We have very few antibiotics left to fight off such bacteria, and once they spread we have no way of stopping it. One way they might spread is through faeces. So when millions lack toilets or proper sanitation infrastructure, these superbugs have been shown to circulate and move through untreated sewage to rivers and other water bodies. There, insects, fish, birds and other wildlife carry them further, contaminating the environment and compounding the cycle of infection.”

The lack of sanitation infrastructure, proper effluent treatment plants and the rise of antimicrobial resistance are fundamentally linked. The life chances of the poor will determine our collective antimicrobial fate, which means that India's poo problem touches humanity as a whole.

Professor Doron and Professor Alex Broom (University of Sydney) have previously published Resistant bugs, porous borders and ecologies of care in India, which relates to this aspect of sanitation. They have also addressed the challenge of superbugs in Chicken Curry in the Time of COVID-19: The Industry of Bugs and Drugs and The spectre of superbugs: Waste, structural violence and antimicrobial resistance in India. They have also authored 


The Bottom Line

Despite the Clean India campaign, India—a rapidly urbanising and densely populated country—still lacks basic sanitation facilities. “These problems should not be simply targeting behavioural change of individuals and further stigmatising and marginalising the poor,” argues Doron. Rather, it is a systemic crisis that needs to be addressed at multiple levels of government and industry so that “it is possible to overcome enduring cultural prejudices relating to religion, caste, gender and class”. The dignity and safety afforded by well built and maintained toilets remains the privilege of the affluent classes, while the poor are trapped by their living and working conditions in a cycle of infection. For toilets to be adopted by a wide range of people, the world needs more than just technology and engineering prowess.

The perfect toilet is not just the one that takes away bodily fluids, but also the one that challenges inequitable social systems and cultural stigmas around human waste. – Professor Assa Doron

Be a Hummingbird

The World Health Organisation has aptly said, "A toilet is small but mighty – just like a hummingbird!" As such, the hummingbird is the symbol of World Toilet Day 2023. In the ancient story, a hummingbird does what she can to fight a great fire – carrying droplets of water in her beak. Her actions – even though small – are helping solve a big problem.

The moral of the story? Everyone can do something to tackle the sanitation crisis. Be like the hummingbird. The more ‘hummingbirds’ there are, the bigger the impact.