Adventures in Lesotho: The Million-Dollar Question

Recently I was video chatting with my dad, telling him about how my day consisted of a 3-hour car ride just to get to the first rondavel receiving outreach services. Just when I think there couldn’t possibly be another village tucked into the mountains so far from town, we always seem to come upon a new group of rondavels. As I was explaining this to him, he stopped me to ask a very thoughtful question, “Where do these people go to the bathroom?” Ahhh, the million-dollar question! I realized that in all of my explanations of Basotho culture and village life, I never discussed the all-important hygiene and sanitation…well here goes!

Some village health workers singing about sanitation and hygiene.

On the first day of outreach, I hadn’t thought much about the toilet situation because at TTL’s headquarters we have a pretty normal bathroom with a septic tank. Not unusual considering many older homes in America still have septic tanks. Out in the villages, however, septic tanks do not exist. As a matter of fact, I’m willing to bet most people out there wouldn’t even know what a septic tank is. Luckily, on my first trip into the villages I managed to not need the bathroom once. On the second, third, fourth, etc. trips, I was not so lucky…

As you might’ve noticed, the rondavels have no toilet, so people must go to the bathroom outside the home. But what happens when there isn’t a bathroom outside the home (which is the case in many rural settings of developing countries)? You simply go where you please. Convenient, yes…sanitary, no. Back in 2000, countries of the UN agreed upon the Millenium Development Goals, which are a set of 8 goals aimed at reducing poverty by 2015. One of these goals hoped to halve the proportion of the world’s population without access to basic sanitation. One of the vital aspects of basic sanitation is having some means of a toilet, whether it be flushable or a pit latrine. As of 2010, 40% of the world’s population have no means of personal sanitation and 1.1 billion people are still practicing open defecation (clearly, we are not on track to meet MDG #7 by 2015). In the developing world, open defecation is a major contributor to disease transmission, especially for diarrheal diseases and intestinal parasitic worms.

Since my master’s defense project is on soil-transmitted helminths (STHs), which are transmitted through feces of animals and humans, I paid special attention to the defecation practices when I first arrived in Lesotho. Most villages have at least one toilet for each group of rondavels (and by toilet I mean a horrible-smelling, tin-like porta-john). Some villages actually appear to have had some organization come in and build one identical toilet for each rondavel. Other villages have no toilet at all, or a toilet still in the process of being built. Unlike a porta-john, though, these latrines are never cleaned out. I am told that, instead, they must get a chemical substance to break down the materials inside the latrine over time.

Left: Tin toilet outside rondavel...Right: Stone toilet outside rondavel.

Okay, so they have some place to go to the bathroom here…but do they really use it? That is actually the million-dollar question. The more I think about it, the more I believe that open defecation is more common than not in the villages. Most of the time, villagers and shepherds are working out in the fields far away from their homes. And guess what they don’t have out in the fields?! (If you said toilets, you’re right.) This means that people are going to the bathroom among the crops they are growing. Furthermore, there’s animal feces everywhere here. It’s seriously like a minefield of sheep and cow dung everywhere you walk, including in the fields where animals graze and families grow crops. These animals can actually pass human parasites in their feces, which poses a large threat to the villagers whom these parasites are looking to infect. What’s more, Basotho use cow dung for fuel. There would be no harm in this, except for the fact that they collect the cow dung with their bare hands (I haven’t seen a single pair of rubber gloves outside the hospital or TTL’s safe home). I was in complete shock the first time I saw women walking down the road carrying buckets of feces on their heads. I hope you are not reading this while eating!

Not a toilet in sight!

Yep, a woman carried this on her head and will work it with her hands into dried dung chips later.

A large pile of dung and dirt ready to be burned for heat.

Sanitation also involves washing hands after defecation or after working in the dirt in general. Since people here do not have taps in their home and must carry water sparingly in buckets, the likelihood that they wash their hands often is not very high. Just look at the kids! I saw one little girl eating dirt the other day, and most of the children here look like they have dirt caked to their bodies at all times. Most of them don't wear shoes either, so they are walking in and playing in (and even eating) a mixture of dirt and feces that could easily result in transmission of life-threatening disease to a child. There is also garbage thrown around everywhere here, especially in the villages where there is no service to remove it. The trash strewn in the grass outside some homes in pretty unsightly, especially in the town of Mokhotlong. Moreover, even many of the people in town have to use a bucket of water and a washcloth to bathe. These practices make Basotho and people living in developing countries sound gross, but it’s really just a matter of not having easy access to the items that keep us clean. This became really apparent to me when my translator asked one women to use her toilet, and she came back into the rondavel with a bucket. I was hoping to use the bathroom as well, but couldn’t build up the courage to go in a bucket that someone else would have to clean up. I have used these “porta-johns” several times now, and let me tell you bringing t.p. and hand sanitizer in your backpack is a life-saver here!

Look at the dirt on these kiddos...

I know this post is kind of gross, but the reality is that having sanitary bathroom practices and making a habit of washing hands regularly has been proven to break disease transmission all over the world (and I just know some of you have been wondering the million-dollar question as well!). Having access to simple things like soap, water, and a toilet are truly vital to hygiene and, in turn, improving global health. So next time you go to the bathroom, be thankful for a toilet that flushes…and wash your hands!!

Foundation of a toilet being built next to this rondavel.