Ebola in the U.S.: MINOR PROBLEM

If you had to choose, which would you rather have: access to the Internet? Or access to a toilet (i.e. indoor plumbing)?

Yesterday the Washington Post published an article stating that 4.4 billion people around the world still don’t have Internet.  The thing about living abroad is that your perspective changes, without you putting in any effort at all. Upon reading that headline I immediately thought to myself: So what?! Several billion people don’t have access to toilets!  If I had to choose one, I would opt for sanitation and hygiene over a virtual update of Kimye’s most recent scandals any day.

I admit the Internet is useful.  I no longer own a bound dictionary because I can use dictionary.com.  When I was learning to drive a manual on the left side of the road, I watched youtube videos for practice. And naturally, as a professor, I use the Internet every day before I teach to see if there are any current events related to my class which I should discuss with my students.  Yes, the Internet is great.  But I don’t think the fact that two-thirds of the world population is sans Internet is all that unfortunate.  According to The World Bank, only 24% of Sub-Saharan Africa has electricity.  You can’t have Internet without at least some access to electricity.  But Obama’s Power Africa initiative is a foolish endeavor (read: DISASTER) which I will save to address a different day.

World Toilet Day is celebrated annually on November 19^th aimed at bringing attention to the need for behavior change and policy implementation “to end open-air defecation.”  Currently, more than 2.5 billion people worldwide do not have access to toilets.  This means they have to relieve themselves in the open.  For those living in rural areas, individuals can try to find somewhere secluded, but this is a security risk.  If you remember that rash of rapes and murders in India recently, many of those occurred because girls had no access to latrines, forcing them to go out into fields to relieve themselves, and there they were easy prey for violent attacks. However, many of these people without access to toilet facilities don’t live strictly in rural areas; many live in incredibly crowded slums in the inner-cities.

When I was in Sierra Leone a few years ago I visited Kroo Bay, one of the largest slums in Freetown, the nation’s capital.  In one Kroo Bay neighborhood 15,000 people live in very cramped quarters with access to four, FOUR (4!) toilets.  Also, it should be noted these are long drops, not toilets with running water.  If you are unfamiliar with a long drop please read my previous post here.  If you would like to see some photos of the Kroo Bay neighborhood, check out this BBC article (be sure to click through the pictures).

The lack of toilets, running water and sanitation is why Africa has an Ebola problem.  When I was in Kroo Bay there was an outbreak of cholera, leprosy was rampant, and the life expectancy was, and still is, 35 years.  Everyone is concerned about Ebola coming to America.  The simple truth is, this should not be a problem here and it should be halted immediately without significant concern.

As Americans we are fortunate.  We have access to running water, thus we can use flush toilets and wash our hands.  We wear shoes, therefore we don’t have to worry about walking around barefoot and potentially stepping in someone’s bodily fluids and contracting a disease.  And for the most part, we live in reasonable accommodations, not cramped living quarters where we are subject to others’ illnesses due to close proximity and the inability to quarantine ourselves (or others) when we are sick.

So, back to the original question: Would you rather have access to the Internet or to a toilet?  I know this may be a tough one for some of you, but try to consider the facts I mentioned above.

Here is a picture I took when I was in Kroo Bay, Sierra Leone.  On the left side you can see a child wearing a blue and white shirt squatting and going to the “toilet.”  Also on the left you can see a woman standing up (there is a man in jeans and a white and gray shirt behind her) who is doing laundry in this creek.  And then if you look on the right side, there is a boy with a bag next to a set of stairs.  Next to that boy you can see the back end of a pig (black and white, or pink? legs and tail):

The Potty Follies

Today as I was driving home from yoga I noticed there was a work crew cutting the grass in the median which divided the highway.  As I drove past the lawnmowers I saw a large van with the words “Work Crew Transport” parked along the shoulder with a trailer attached.  On top of the trailer was a port-a-potty which someone from the work crew was exiting.  I couldn’t help but think, It must be strange to use a port-a-potty on the side of the highway with traffic speeding by outside at 65+ miles per hour.  Then I thought, How strange to have a port-a-potty, after all you could just go along the side of the road like everyone else.  Then I remembered, I’M NOT IN AFRICA!  You can’t just GO along the side of the road, I think you get arrested for that here!  (Please refer back to the previous post about adjusting to life back in the western, civilized world.)

Yesterday I flew to Miami for a meeting. I arrived first thing in the morning and then was scheduled to return to Baltimore the same evening.  I told the person who was taking me back to the airport for my return trip that “I didn’t bring any luggage (or my African bug out bag), but you know, I threw my toothbrush, and a few other necessities in my purse just in case I got stuck here.”  He said, “You know, we do have Walgreen’s and CVS.  If your flight gets cancelled you could just go buy whatever you need.”  I thought about it for a moment and then said, “I guess that didn’t really occur to me.  I think I’m still in Africa-mode.  Every time I leave the house I carry toilet paper with me in case I can’t find it anywhere because I’m used to never finding toilet paper, or a real toilet for that matter, most places I go (in Africa).”

Let me explain what I mean by “I seldom find a REAL toilet (in Africa).”  Plumbing is very limited in most of Africa.  Most people have detached outhouses. Even if you have indoor plumbing there is no guarantee it will work properly due to water restrictions.  You can’t flush the toilet if there is no water.  When I first arrived in Botswana there was no water in my building on campus for 7 weeks.  Unfortunately people would continue to use the toilets, but they didn’t flush.  In the African heat that equals unpleasantness.  But most of Africa doesn’t have what we call western toilets.  This is a western toilet:

You might, emphasis on might, find western toilets in government buildings, airports in major cities and well-funded universities.  IF, emphasis on IF, you find a western toilet, it is highly unlikely there will be a toilet seat or toilet paper.  It will probably look like this:

In most of Africa, and most of the world, you will find what is called a stand up toilet or a long drop.  Here is a stand up toilet which does have water, and thus actually flushes- sort of:

I was explaining a stand up toilet to friends back home (I was in Africa at the time and they were in the U.S.) and they had never heard of such a thing.  I sent them a picture and they thought I was making this up.  I consider the fact that I am writing a blog post entirely about toilets 1.) kind of ridiculous, but also 2.) a public service announcement and warning to anyone that is considering travel to a third world country.  Stand up toilets are also prevalent in India and China.  Now, not that I am advocating for these types of facilities here, but stand up toilets are considered more biologically beneficial.  What that means is that almost no one in India or China ever has a hip replacement. Why? Because they are continually bending the way the body is designed to and thus, they have healthy hips.

One step down from a stand up toilet is what we call a long drop.  It means exactly that.  Basically it is a hole dug in the ground.  You put your feet where the two large ovals are.  If you need more explanation than this please contact me directly:

The above examples are standard waste disposal facilities.  Of course, the African bush is quite expansive. If there are no toilets (western or stand-up) or long drops available you can always go behind a tree or rock.  Of course, sometimes you are in the middle of the desert, so there is no privacy available.  Oh well, it happens.

Since I’ve already gotten this far, I figure I should give you some tips on what to do if you are ever travelling and need to be prepared for “alternative” bathroom facilities:

1. Carry toilet paper with you at all times.  When I was in Namibia I was told a story of an Italian couple who used leaves from a nearby bush because they didn’t have TP.  Turns out the plant causes blindness (from touching the leaves and then touching their faces).  
2. Bring a plastic ziplock.  This is in case you go behind a tree, rock, or out in the open.  Don’t pollute the environment with your used TP.  Put it in the ziplock and then dispose of it properly later.  This isn’t a necessity, but it is considerate.
3.  Two words: hand sanitizer.  This should be self-explanatory, but it can also double as a cleaning agent in case you don’t follow tip #4. 
4. Wear close-toed shoes and long trousers.  There are a few reasons for this: First of all, most ladies can’t guarantee their aim will be perfect. (I can’t speak for the gents on this issue.)  There is nothing more annoying that getting your leg/foot wet. (I don’t know this for sure.  This is what “friends” tell me.) In the event you are wearing flip flops AND your aim is bad you might slip on the porcelain stand-up toilet.  Said slip may result in a foot getting lodged in the hole. (Again, I can’t say I know this first hand, but “friends” assure me this happens from time to time.) 
5. In the event you don’t follow the advice in tip #4, try not to panic, phone a friend, get them to help you dislodge yourself from the toilet, and then if you remembered tip #3 and #1 you can use hand sanitizer and TP to clean off your leg. 
6. Laugh.

I’m sure most of you reading this blog post will never have to worry or experience anything I’ve described to you here.  BUT!  If any of you do in the future- even if it is 50 years from now- I bet you will remember this.  I expect at some point I will receive an email along the lines of, “Dear Dr. Phelan, you were right about the stand-up toilet.  I forgot the TP, didn’t have sanitizer and wore flip flops.  What a mistake!  Lots of Love, Your Former Student/ Friend/ Family Member/Stranger Who Read Your Blog”  I tried to warn you. :)