Reflections on Community Led Total Sanitation in Nepal
This article reflects on the notion that Community-Led Total Sanitation (CLTS) captures the ‘power of shit’ and draws on the disciplinary effect of the disgust that it elicits. Theories of disgust help explain this disciplinary power and provide a useful lens to elucidate processes at work in the CLTS approach. Despite divergent theoretical explanations as to the origin and ‘purpose’ of disgust, there is considerable consensus with regard to its characteristics and components. Reflections in this article are drawn from an explorative study about the sensitivity of health promoters working in programmes aiming to prevent Open Defecation (OD). The study was primarily literature based and a visit to the Rural Water Supply and Sanitation Project in Western Nepal (RWSSP-WN) served as a case study. The RWSSP-WN bases its approach on principles of CLTS and within this approach there is an apparent contradiction as is evident in this quote: “It is the use of strong and vulgar language that creates the best results in achieving ODF [Open Defecation Free] status and sustaining total sanitation in our communities. We have also realised that consistent use of the most unpleasant words for shit have created an enabling environment …” (Zombo 2010: 74). This statement begs reflection; at face value it seems contradictory, as how is it possible that consistent use of unpleasant words and harsh confrontational techniques can create an enabling environment? How can an offensive strategy lead to mutual social respect? This question stimulated further study into mechanics at work when disgust is triggered in a public sphere.
The first section of this article provides an introduction to CLTS and the second a brief explanation of the author’s background. Following this, in the third section, an overview of disgust and a brief account of various theoretical perspectives are given. The final discussion is structured according to these perspectives and integrates these with reflections from the case study in Nepal to explore the ‘power of shit’ and the mechanics at work when disgust is elicited in the CLTS approach. The article concludes with a challenge to consider the role disgust may play in other health related fields.
Community-Led Total Sanitation (CLTS)
Prior to the inception of CLTS, experience in sanitation and hygiene projects revealed that projects providing hardware to construct latrines and toilets were discouragingly unsuccessful after three decades (Kar 2003). CLTS was initiated in Bangladesh in 1999, in response to an evaluation of a sanitation project where existing top-down and heavily subsidized approaches were ineffective (Kar & Bogartz 2006; Chambers 2009). The pioneer of this approach is Dr. Kamal Kar, a development consultant from India. With his vast experience in participatory approaches in development work, Kar’s approach succeeded in tapping existing motivation in local communities to trigger a sense of demand for improved sanitation (Kar 2003; Kumar & Shukla 2009).
Since its inception in Bangladesh in 1999, CLTS has gone global, and has been implemented more widely in Asia, Africa, Latin America and the Middle East (IDS 2011). The approach is now being used in 43 countries (Chambers 2009). It has been hailed as a ‘spreading revolution’ (Lenton et al., in Deak 2008). In 2008 a Bangladeshi partner to WaterAid, Village Educational Resource Centre (VERC), revealed that in Bangladesh alone, CLTS had spread to nearly 1,500 villages benefiting almost two million people. Indonesia soon followed suit and in the same year, nearly 15% of the country were implementing the approach (Deak 2008). The aim of CLTS is to achieve Open Defecation Free (ODF) villages. In Nepal, this occurs when the following prerequisites have been met: a three month minimum period since the beginning of ODF activities; every village household must have and be using a latrine; toilets and latrines must be used ‘properly’; there should be no evidence of OD and every institution in the village must have a toilet. The declaration of ODF status is made following house to house visits and verification by a neighbouring village or another Village District Council. In 2007 CLTS had been implemented in over one hundred communities across the country and within a two year time span ten out of 25 clusters (a cluster is a group of three to four communities) had been declared ODF (Plan Nepal 2007).
CLTS facilitators identify key influential people in communities that assume the role of ‘triggerer’. These ‘triggerers’ are instructed that they should neither lecture nor advise on sanitation, but rather facilitate a process whereby fellow community members see for themselves the consequences of OD. As well as adopting a firm anti-subsidy stance, CLTS emphasises triggering behaviour change, primarily through eliciting disgust. It is beyond the scope of this article to address the anti-subsidy stance, the emphasis here is to reflect on the way disgust is used as a tool in the CLTS approach. Integral to the use of this tool are the characteristics of facilitators and triggerers and these will also be described in this paper.
The following techniques, which characterise this approach, were referred to as the five triggering tools in Nepal:
- ‘Defecation Area Transect’ involves a walk around targeted villages. Essentially, this walk involves participating members of a community taking a group of outside dignitaries on a walk through the village to identify common areas for OD. In Nepal, they take this a step further and spend time prodding the excrement with sticks, deliberately eliciting higher levels of disgust. Despite the humour that is clearly employed, this walk is commonly known as the ‘walk of shame’.
- ‘Sanitation Mapping’ involves identifying and drawing maps of household latrine status and taking note of which households do or do not have a latrine. Included on the map are common sites for OD with a record of which people frequent that particular site.
- ‘Calculation Flow’ calculates the amount of faeces per person, per household, per village, over a set period of time. Common places in villages that are regularly frequented by households for defecation are indicated on the map and are connected to households. On the basis of this a calculation is made as to the amount of faeces building up daily in the village.
- ‘Social Mapping’ diagrams are drawn to trace routes of faecal contamination including ponds, utensils, and food. They are used to record baseline data and provide a visual reference for future verification of the discontinuation of OD.
- ‘Glass of water’ technique takes place during the ‘defecation area transect’ described previously. When human faeces is found, the person leading the walk, takes a strand of hair, passes it through the faeces, dips the ‘faeces coated hair’ into water and then offers it to the group to drink. Although faeces are not visible in the water, not surprisingly, no one wants to drink it.
As soon as the community is triggered, facilitators initiate the process of planning how to achieve ODF status of the community through collective behaviour change.
The sensitivity of this topic demands an explanation as to what is on my ‘slate’ as despite the innate aspects of disgust, there is no denying the influence of culture and context on both perception and expression. Although born into a middle class family of European descent and raised in New Zealand where OD hardly occurs, it is not a practice that is totally unfamiliar to me. I lived for a period of ten years in both Nigeria and Indonesia where it is more common practice. Additionally, for several years I was in a relationship with a high-level tetraplegic, of Maori descent, who required routine management of his bowels. This undoubtedly had an impact on my own perceptions of defecation, as well as raising my awareness of the influence of culture in dealing with taboo issues. Professionally, I have worked in a variety of health settings inclusive of Leprosy programmes, Psychiatric units and an HIV/AIDS hospital ward. These experiences resulted in my placing high value on communication skills and in particular the ability to listen and search for underlying meanings motivating people’s behaviour. With regard to sanitation and hygiene practices, these years taught me to recognize the relative nature of this topic; perceptions of what is ‘dirty’, or not, are determined by different contexts.
Finally, going to Nepal for the field trip was not my first encounter with Nepal and its people. For a number of years, I have been delivering a communication and advocacy course for health workers there. This course led to my introduction to the Rural Water Supply and Sanitation Project in Western Nepal (RWSSP-WN) and their Community Led Total Behavioural Change (CLTBC) approach which is based on principles of CLTS. I was keen to find out more and it seemed a worthwhile subject to investigate further, and stimulated a curiosity to find out more about theoretical underpinnings of disgust.
Theoretical perspectives on disgust
The ‘power of shit’ is undoubtedly a result of the disgust that is elicited when people are closely confronted with human faeces in public spaces and this contributes to its use as a ‘tool’ in CLTS. It is beyond the scope of this paper to provide a detailed account of the complexities of disgust, however, there are certain aspects that I believe have particular relevance to this article. Disgust is a complex phenomenon. It is both physical and psychological, and provokes strong visceral, emotional and cognitive as well as social reactions, to a vast array of elicitors. Adding to the complexity of this phenomenon, or as Miller (1997) calls it, this ‘syndrome’, are diverse theoretical explanations. These invite speculation about the purpose and impact of disgust from fields as varied as philosophy, evolution, psychology, and sociology and anthropology. Despite the apparent tensions in some of the explanations, there is consensus about properties related to disgust. Various theoretical perspectives as well as some of the well-recognized properties of disgust will serve to structure reflections in the discussion.
Philosophical perspectives: ‘To be or not to be’
Philosophical perspectives help to understand the significant contribution disgust makes in ‘shaping’ our very being. Menninghaus provides a detailed overview of philosophical descriptions of disgust and most of the descriptions that follow are drawn from his account. He draws attention to its dual nature, asserting that it has a cognitive aspect that demands awareness of its object, and simultaneously it commands ‘a categorical imperative of action’ toward removal of the object. He stresses that disgust presents an acute sense of self-preservation in the face of ‘unassailable otherness’, and quite literally brings us to the question ‘to be or not to be’ (2003: 1).
Menninghaus writes that Kant called disgust a ‘strong vital sensation’ that affects the whole nervous system, resulting in a state of alarm and emergency (2003: 1). He highlighted aesthetic determinants inherent in disgust, and inferred that it provides the basis of our common sense, and serves in an informal manner to contribute to the coherence of society.
Menninghaus reminds us that Kant and Mendelssohn considered disgust to be a “dark sensation that so categorically indicates something ‘real’ that it strains the distinction between real and imaginary” and Nietzsche went so far as to refer to it as an “authenticity-marker of metaphysical insight (2003: 84). In experiencing disgust, we access a powerful form of comprehension in that cognition is supported by physiological changes (Menninghaus 2003: 9). Its aesthetic operative mechanism is evident in the resulting powerful ability to ‘discern’. This discernment facilitates a “capacity to judge and recognize the tawdry, the cheap, and the fulsome” (W.I. Miller 1997: 169). Korsmeyer affirms this train of thought, in her assertion that “we can distinguish that which tastes good by looking for the opposite of that which disgusts” (2002: 218). She extends this notion as a challenge to those who reduce disgust to an aversive reaction in pointing out that people who enjoy ‘haute cuisine’ are often required to conquer disgust when eating certain foods such as strong and well matured cheese.
Kolnai (2004) took yet another perspective on the concept of dirt and disgusting objects by underlining its disturbing and disfiguring effect and asserts that these realisations are deeply imbedded and not easy to shake off. Furthermore, he stresses the challenge and provocation involved in disgust, highlighting the ability that disgust both lures and repels, invites and deters.
Philosophical perspectives draw attention to the transformative role of disgust. Disgust is a short lived emotion and implicit in this is the necessity to overcome it. Often what is at stake here is the concept of ‘laughter’. Menninghaus goes so far as to say “All theoreticians of disgust are, at the same time, theoreticians of laughter” (2003: 10). Through laughter we release tension that disgust builds and this contributes to the humanizing character of disgust, as W.I. Miller states, “to feel disgust is both human and humanizing” (1997: 11). Essentially, philosophical perspectives on disgust reveal its role as a positive operator as well as its ability to discern, and, in particular, to discern what is harmful.
Evolutionary perspectives: Contaminating effect
Evolutionary perspectives shed light on the origins of disgust and its ‘protective’ nature that operates to discern and warn against harmful agents.
Darwin described disgust as revulsion triggered by taste, and drew attention to the idea that it is not confined to literal taste, but is triggered by the mere prospect of tasting something. He said that as such it is secondary to similar feeling involving a synergy of senses inclusive of olfactory, kinetic or and visual. (Rozin & Haidt2008: 757). Furthermore, Darwin connected disgust to a characteristic ‘gaping’ facial expression. He was able to provide evidence that all adults have the capacity of feeling disgusted and discovered the recognisability of facial expressions across cultures (Kelly 2011). Angyal (1941) extended the taste based perception to the ‘mere thought or prospect’ of oral incorporation of an offensive object.
Rozin and Fallon built on this in their definition of ‘core disgust’ and emphasized the ‘contaminating’ effect of the offensive object and asserted that even brief contact with the offending object will “render that food unacceptable” (1987: 23). The emphasis in these perspectives is on oral ingestion or the mere thought of oral ingestion as an elicitor of disgust.
More recently, Curtis and colleagues confirmed the evolutionary perspective and emphasized that disgust is a mechanism to protect against infection (2001; 2004). In their most recent paper, they claim that “the disgust system is a psychological mechanism for producing pathogen avoidance behaviour” (2011: 389). They provide compelling arguments based on diverse studies, including neuroimaging and large scale surveys involving thousands of participants. In these studies, participants were exposed to various disgust elicitors. They conclude that “it can be seen that all of disgust’s basic elicitors … are implicated in the risk of transmission of infectious disease” (2011: 390). Furthermore, they assert that the “relationship between disgust elicitors and disease sources appears consistently across cultures and through the historical record” (2011: 390).
Psychological perspectives: Does not sit easily on the nature-nurture divide
Psychological perspectives highlight the cognitive role of disgust, and yet increasingly acknowledge the duality of disgust in terms of its social-cultural role.
Rozin and Haidt adhere to the idea that disgust has its origins in food, and that functionally it works to reject unwanted food and odours, citing as evidence the distinctive associated physiological response of nausea (2008: 758). They refine this notion in what they have termed ‘core-disgust,’ where they encompass Argyal’s notion about the ‘mere thought’ of moral incorporation of food and they extend it to associative disgust. Translating that even brief contact of an acceptable food with contaminated food renders it unacceptable (2008: 757). Affirming the basic premise here, other psychologists claim that indeed disgust serves to guard both the physical self as well as the social self (Fessler & Haley 2006; S. Miller 2004, in Rozin et al. 2008).
Kelly, states that disgust is “a piece of human psychology that does not sit easily on either side of the traditional nature-nurture divide” (2011: 1). He acknowledges the apparent contradiction that disgust is neither learned nor taught, and yet variation exists in what people find disgusting. Despite the innate element of disgust, people can learn to be disgusted by certain things as a result of individual experience and interactions with others, as well education and moral and aesthetic responsiveness. Psychological contributions have much to say in regard to both ‘elicitors’ of disgust, as well as the behavioural consequences, and there is little doubt universal similarities exist in these domains. Furthermore, Kelly elaborates the distinction that exists between elicitors of disgust and responses to disgust. He makes a further distinction in regard to responses, breaking them into three components, namely, the affect programme, core disgust and downstream effects. The affect programme is a reflexive response that when triggered results in typical behavioural as well as physiological reactions that are enriched with qualitative feelings. Core disgust, drawn from Rozin and Fallon (1987), is more cognitive with three core features, a sense of oral incorporation, a sense of offensiveness, and contamination sensitivity. The effects of core disgust are more cognitive in that they go beyond pulling away and tend to capture attention. Disgusting objects are perceived as unclean and dirty and the reaction is to seek distance, accompanied by a desire to clean oneself (Kelly 2011: 18-20). The ‘downstream effects’ refer to the influence disgust can have on the way we evaluate and judge a variety of issues.
These perspectives shed light on some of the ‘side-effects’ of disgust and illustrate machinations it sets into motion in terms of policing the body.
Socio-anthropological perspectives: Order and disorder
Socio-anthropological perspectives pay considerably more attention to the symbolic attributes of disgust and the ‘meaning’ it holds. One of the most notable contributors to this perspective, Mary Douglas (1966), proposed the concept ‘matter out of place’ which helps clarify the meaning of dirt and, consequently, disgust. Dirt is not seen as merely biological or material matter but becomes significant in relation to social order and disorder. Douglas’s position in the debate about disgust is that she criticises the evolutionary perspective if it presents itself as an ultimate and exclusive theory of the origin and meaning of disgust: “There is no objection to this [evolutionary] approach unless it excludes other interpretations” (Douglas 1966: 44). Arguing – as some evolutionists do – “that even the most exotic of ancient rites have a sound hygienic basis,” is naïve and reveals a bedevilment by what William James long ago termed ‘medical materialism’ (Douglas 1966: 41).
Van der Geest (2007) expands on Mary Douglas’s claim that there is no such thing as absolute dirt but rather ‘matter out of place’, by injecting a social dimension to the idea that dirt is defined by its context. In regard to ‘faeces’ and the disgust that they elicit, he proposes that ‘matter of place’ is first of all a ‘matter of whom’. This perspective is illustrated in the following account given by the great evolutionist Darwin himself: “… a native touched with his finger some cold preserved meat which I was eating in our bivouac, and plainly showed utter disgust at its softness; whilst I felt utter disgust at my food being touched by a naked savage, though his hands did not appear dirty” (cited in: W.I. Miller 1997: 1). The ‘savage’ was disgusted by this close encounter with the meat, and Darwin disgusted when seeing the hands touching the meat. For Darwin the proximity between savage and meat was highly significant, for the savage it was possibly the appearance, odour of nature of the meat that was disgusting. When reflecting on this it seems apparent that the source of disgust for Darwin was not the ‘meat’, but the person briefly connected to the meat, the ‘naked savage’.
Where psychological explanations pay attention to the cognitive processing of contamination effects of disgust, socio-cultural perspectives highlight the social effects of contamination, inferring that contact with the disgusting makes the person disgusting (S. Miller 2004). Miller recognizes the political implications of disgust, recognizing the way disgust serves to hierarchize political order (W.I. Miller 1997). He believes disgust plays a role in not only maintaining social hierarchy, but that it helps constitute claims for superiority, and determines placement in social ordering, and is often used as a marker of otherness. In this way, disgust plays a motivating and conforming role in moral judgment that operates to ‘rank people and things’ in a kind of cosmic ordering. Finally, Miller concludes that disgust “convey(s) a strong sense of aversion to something perceived as dangerous because of its powers to contaminate, infect, or pollute by proximity, contact or ingestion” (W.I. Miller 1997: 2).
Deductions from theory
It is evident, as Kelly noted, that “disgust is ubiquitous … something interesting can be said about its character from nearly every level of analysis … from its associated patterns of neural activation to its role in large scale cultural dynamics” (2011: 12). The above mentioned theories, analysing how disgust operates, elucidate mechanics at work in CLTS. CLTS has apparently captured this powerful and complex emotion, comprising physical, psychological, social and cultural as well as moral aspects.
In the following section, various characteristics of disgust, and the way it is being implemented as a ‘tool’ in CLTS, will be discussed and integrated with reflections from the case study in Nepal.
Characteristics of disgust: The Nepal case study
Despite divergent, and at times contentious, theoretical perspectives on disgust, there is considerable agreement about the characteristics of disgust. In this section, I will review some of these characteristics and will relate them to the CLTS approach in Nepal.
The comment made by W.I. Miller (1997) that all theoreticians of disgust are theoreticians of laughter, resonates well with me, as the same can be said of researchers of disgust. Going to Nepal to conduct a case study on Open Defecation generated humorous remarks both at home and in Nepal. I have become known in some circles as the ‘shit’ expert. There were peals of laughter when friends heard what I was going to do in Nepal: “Most people go to Nepal and return with photos of the Himalaya, you come back with photos of toilets!” Furthermore it was impossible to let friends in Nepal know what I was doing without it resulting in muffled giggles and smirks behind shawls.
As with any research, I think, first impressions are often the most vivid, and I recall my initial shock when learning from numerous Nepalese that they found the idea of defecating within in four walls and with a roof overhead, disgusting. This reaffirmed for me the notion that disgust is more than a hard-wired reflex, but is shaped and moulded by numerous inputs inclusive of context, experiences and culture. In saying this there is, however, undoubtedly a strong reflexive aspect to disgust and a visceral response that can defy such external influences.
Regardless of theoretical background few theorists dispute that disgust has a powerful instinctual effect that can result in involuntary nausea, recoil, retching and startle. Menninghaus refers to these visceral aspects as representing “a state of alarm and emergency … a convulsive struggle” (2003: 1). Kelly makes the point that people do not have to learn how to be disgusted, and extends this to state that “… one does not have to be taught to be disgusted by certain things …” (2011: 12).
Not surprisingly, this effect is evident in descriptions of people’s reactions during CLTS shit transect walks (Kar & Pasteur 2005). One of my RWSSP-WN informants in Nepal, when describing the ‘defecation transect walk’ had the following to say:
And when we do that shame of walk …that was very powerful, cos if we start touching there and the people they start vomiting and covering their nose and mouth…
As noted earlier, Curtis et al. assert that the “disgust system is a psychological mechanism for producing pathogen avoidant behaviour” and claim that it is a “universal driver of pathogen avoidance” (2011: 389). There is much to support their claim in regard to the outcome of various studies they cite, inclusive of studies that affirm universal characteristic facial expressions such as a gaping mouth, behaviour patterns such as withdrawal and shuddering, physiological changes inclusive of blood pressure, skin changes and nausea (Curtis et al 2011). I wonder, however, what role the context also had on these reactions. I assume that if the close encounter with the shit had not occurred in such a public place with so many people, the reaction may have been less severe. Van der Geest supports this notion in his observation that “… primary disgust in a pure sense does not exist. All human feelings take place and exist in a context and derive meaning from that context … the most important context of faeces and defecation is the person or agent who produced the dirt”(2007: 386).
Nepal reflections on visceral aspects
CLTS exposes the producer of the shit in a public space, the shit is no longer ‘anonymous’ but the faeces are now ‘connected to someone’ or a household. I CLTS also extend their approach to school situations, where it is referred to as School Led Total Sanitation (SLTS). In this setting this principle of removing the anonymity and exposing the ‘culprits’ is clearly evident. Here is what one informant had to say:
School led total sanitation approach … they will learn from the schools to build the toilet … and they take that message to the home … through the school they put a map which student has toilet in the home and which does not … and because of that it is also quite a kind of shame for the children a kind of trigger to have a toilet in his home… in schools I have seen a big sign… of all the students with the social map and all the children with their households and those students who do not have toilet that is there.
And W.I. Miller alludes to it when quoting Angyal (1941), who asserted that “wastes are not contaminating because of any obvious noxiousness but because they ‘signify’ inferiority and meanness.”
Relatively little recognition has been given to disgust’s cognitive effect. It provides information about the outside world that is unavailable by other means (Kolnai 2004). Kolnai draws attention to the fact that it is highly sensory and as such “cannot dispense with direct reference to the sensory processing of its elicitors” (2004: 34). Miller affirms this in his statement “All emotions are launched by some perception; only disgust makes that process of perceiving the core of its enterprise” (W.I. Miller 1998: 36). Furthermore, disgust leaves an indelible imprint on memory, it commands attention and research has affirmed that people have sharper recall of disgusting things than neutral ones (Kelly 2011). It is this aspect of disgust that makes what is happening in CLTS so interesting. It is drawing on its potential to elicit a strong response to stimulate cognition and in doing so facilitates judgment and inference. This notion was reflected by one of the respondents:
This shame … and once they realize and they became the shame and they can start thinking … this is the logic.
Yet another respondent had the following to say in reference to the ‘calculation flow’:
Almost all community with whom we do this exercise (come to realize) most Nepali eats two kilo of shit in a year… and that makes people really ashamed… gets people really thinking.
The ‘glass of water’ technique, that was described earlier, illustrates the cognitive impact of disgust. It was stated by the majority of respondents as the most effective technique in CLTS. Most of the project workers that I met and held focus group discussions with were from the communities that were being targeted and they had previously practiced OD themselves. When discussing the ‘glass of water’ technique, the conversation usually became animated, and there was visible evidence of how convinced they were of the cognitive impact of this technique. Clearly, the act of ‘contaminating’ water with faeces and then offering it to the people on the transect walk, cognitive gears were switched into action. One of the most common statements from RWSSP project workers was: “We had no idea we were eating so much shit”!
When asked what they believed was the best way to prevent OD, responses included the following:
“To show them they are eating shit” … “To teach that we are unknowingly eating our faeces” … “Eating faeces seeing or without seeing” … “Make them realize they are eating shit and the health effects of it” … “By pouring water in the glass and giving it to drink then dipping a hair in faeces and again dipping it into the water of the glass and giving it to drink will be the best way”.
The consequences of faecal-oral contamination are brought to the fore in this ‘glass of water technique’.
Kolnai, however also, reminds us that disgust is a complex phenomenon that has a certain ambiguity about it: “The supposition that disgust is merely a mixture of nausea and contempt is nothing but a cheap, unphenomenological jest.” He continues to assert that disgust both grounds moral perspectives as well as casting doubt upon their validity (Kolnai 2004: 35).
The significance of proximity in relation to disgust should not be underestimated. It is often elicited via peripheral pathways as is evidenced by the sensory organs it stimulates. Kolnai aptly describes this in reminding us that it is almost as though the disgust arousing object crawls over the skin and assaults the sensory organs and extends to the stomach: “… the disgusting object grins and smirks menacingly at us. The way in which it achieves these effects and their associated responses will throw further light upon the moment of proximity” (2004: 41). CLTS deliberately plays with this notion of proximity as is evidenced in the ’defecation transect walks’ and as was evident in Nepal with the prodding of shit to reinforce and as it were increase the intensity of disgust. Furthermore, faecal routes of contamination are deliberately sought out and people are literally confronted with each other’s shit as they stand close and are offered ‘shit contaminated’ water to drink. This view is echoed in the following statement of a respondent in Nepal:
Talk about this OD and … the disadvantages and how this OD can affect to us and how that can contaminate the water and how that goes from mouth to finger and from mouth to mouth.
Proximity becomes a central issue as people on the transect walks desire to remove themselves to escape an uninvited and unwelcome nearness. When disgusting objects, such as shit, come too close, they arouse a fear of contamination that threatens our sense of cleanliness and not least our ‘uprightness’. Moreover, the effect of this is such that it tends to result in our wanting to clean up. The following comment from one of the respondents is indicative of the impact of this notion of contamination:
If one person, doesn’t have a house only that person will suffer … (but) if one house doesn’t have a toilet … all the community will suffer that OD … and this is the community pressure for that household to build the toilet.
Kolnai points this out in the distinction he makes between fear and disgust (2004: 42). Fear, he asserts, “…coerces me principally to retreat from my surroundings … disgust leads me much more to a cleaning up of my surroundings, to a weeding out of what is disgusting…” Disgust is inherently provocative with the ability to challenge us and stir us into action. I recall vividly the surprise and astonishment I felt when entering a village where CLTS was actively being implemented in a reasonably remote hilly district. I have visited many villages in low-income countries, but this village was different to any I had seen before. Most striking was the cleanliness, and presence of rubbish containers and plastic bags nailed to trees. We were taken to visit some homes that had recently constructed latrines, the pride and visible pleasure of the villagers was clearly evident. There may be a number of factors to account for this, it could have been all staged as they knew we were coming, it may have been a one off effort to have the place looking impressive for the visitors, or it really was an impressive display of real change in sanitary conditions in the village.
In regard to the moral significance of disgust, the ability that disgust has to assault our sense of ‘uprightness’ is important. Miller links this to the sense of contempt that disgust often arouses, “… [these emotions] confirm others as belonging to a lower status and thus in the zero sum game of rank necessarily define oneself as higher” (W.I. Miller 1997: x). Miller also refers to the moral function in terms of the ability disgust has as a “necessary builder of moral and social community. It performs this function mostly by separating our group from their group …” (W.I. Miller 1997: 194). Clearly, disgust is more than a visceral response, more than an emotion; it is a powerful social and cultural signifier that plays a motivating and conforming role in judgments of morality. It has a potent role to play in terms of maintaining or rescinding public images of purity and dignity. Miller uses the example of ‘soup in a beard’ to illustrate this. When we see soup in a beard, it is neither the soup, nor the beard that creates a sense of disgust, but rather our sense of disgust tends to be directed toward the man who is somehow ‘contaminated’ with a faulty character in that he is unable to keep himself clean (W.I. Miller 1997: 4). Furthermore, the judgement cast toward this man, is more severe because of the ‘nature’ of what is in the beard. It would be less disgusting if the matter in the beard was something less intimate, for example a piece of straw. The disgust response and the associated moral judgement is more severe because the soup was first in the man’s mouth and as a result we are confronted with a traversing of etiquette, what goes in the mouth must should remain there. I am sure this mechanism of disgust that results in moral judgment helps explain the apparent success of CLTS, especially when people’s ‘dirty practices’ are exposed in a public sphere.
It seems paradoxical then, that an emotion that has such a powerful socially signifying and dividing role also has a strong element of humour. It seems clear to me that it is this aspect of disgust that facilitates its use in the CLTS approach.
As stated above, despite its highly sensual and visceral character, disgust shares some common ground with humour. Anyone will recall an occasion when ‘disgusting’ issues resulted in blushing and laughter. Even though we are frequently repelled and do all in our power to avoid disgusting situations, we must admit to occasions when we are fascinated and have a certain ‘unhealthy’ attraction for the disgusting. As Rozin (cited in Lewis 2008: 769) states, “Disgust stimuli often elicit amusement.” When I visited a village and went with a small group of people for a short ‘mock walk of shame’ to find human faeces in open spaces, the same happened: giggling reactions from those who joined us. I am sure this irrepressible humour, surfacing in company when confronted with ‘disgust’, plays a major role in facilitating the use of these confrontational techniques.
McGinn has the following to say about humour in relation to faeces “We joke about shit because we find it embarrassing, discomforting and also funny… Shit is always good for a laugh” (2011: 63-4). He goes on to highlight that humour is characteristically related to taboo and topics that generate unease, and jokes that are generated by disgust serve to neutralize our feelings because of their counteractive amusement value. Furthermore, McGinn draws attention to the physiological comparisons with laughter and disgust, and implies that the shared “form of explosively and noisily expelling something from the mouth” facilitates a sense of relief (2011: 211).
Characteristics of disgust are complex and interconnected (see diagram below).
Destabilising social relations
The ‘glass of water’ technique, that was described earlier not only illustrates the ability of disgust to kick cognition into action, but it also demonstrates the socially ‘destabilising’ role that OD has on communities when confronting people in a public sphere with issues that were previously invisible. Not only the ‘contamination’ effect of the faeces in a physical sense, but social relations were being brought into play. People engaged in OD are now perceived as not only contaminating themselves but others in the community and they assume an undesirable status as a ‘culprit’
The destabilizing impact was voiced during a FGD held in one of the districts. The discussion turned to a village that wanted to be declared Open Defecation Free (ODF). One of the women in the discussion came from this village and became very angry with another member of the group from a neighbouring village. She accused people from the neighbouring village of sabotaging the chances of her village being declared ODF as she believed neighbouring villagers were coming and deliberately openly defecating in her village. This angry accusation of the woman demonstrated the impact and destabilizing effect that contamination perceptions can have on social relations.
A similar finding was reported from a study to address the social dynamics involved in CLTS that was conducted in Bangladesh. The following was stated: “The women mentioned that latrine installation at households contributed in harmony among them. Previously while cleaning the backyard they found faeces and used to rebuke their neighbours which resulted to a quarrel. Sometimes quarrel also occurred if someone’s child defecated in other’s premises” (Mahbub 2008).
Social significance of shit: “A toilet, it’s a kind of status symbol”
Mary Douglas’s concept of ‘matter-out-of-place’ cautions that issues concerning ‘dirt’ should not be solely addressed or explained in medical terms, but need to be understood in the wider social and cultural context of the individual or group. Douglas further asserts that people’s efforts to shun dirt imply an attempt to maintain or restore social order (Douglas 1966). She reframes conventional notions of ‘dirt’ encouraging us to accept that “… dirt is essentially disorder.” (1966: 2). She emphasizes that removing dirt is a positive effort to create order and organize environments.
Anthropological discourse on pollution and purity affirms this line of thought, stressing that pollution and purity beliefs dictate social categories that are assigned to people (Ortner 1973). Ortner highlighted the mechanics of this process in her paper “Sherpa Purity” where she explored “the underlying relationship between explicit culture forms (‘symbols’) and underlying cultural orientations. It assumes that the two are intimately interrelated, indeed inseparable, and further that it is the symbolic forms themselves which are the mechanisms underlying cultural orientations to observable modes of socio-cultural action” (Ortner 1973: 49). Ortner’s primary concern in this paper is with ‘pollution’ and what is considered polluting for the Sherpa. Her findings shed light on the fact that pollution practices indicate social status, and she notes that in India the system of pollution practices serves as a charter for the caste system (Ortner 1973). These dictates play a significant role in the dynamics that occur between different classes or castes and serve to reinforce social positions and attributes
Evidence of the social significance of dirt was evident during the visit to Nepal. One of the most vivid impressions reflecting this was during a visit to the home of a young Dahlit (outcast) woman who had recently built a latrine in her home. It was clearly inferred, by one of the project leaders, during that visit that her social status in the village had increased significantly since she built the latrine. Although she would remain a Dahlit due to her birth, her status had changed considerably and she would no longer be shunned by the community.
This was also echoed in the focus group discussions and in-depth interviews where a large number of respondents replied affirmatively to a question about whether or not people’s social status had increased since building latrines. For example, one respondent referring to the practice of OD remarked:
The people who do have knowledge about it … they want to introduce themselves as a high quality person of the community…
When interviewing a Junior Technical Advisor to the RWSSP-WN, about latrines and social status, she stated the following:
If you go to the village you will always find that the richest person in the village will definitely have a toilet… so it is kind of a status symbol even in the villages…
There is little doubt the construction of toilets or latrines and the accompanying ‘technology’, no matter how sophisticated or simple it is, stimulates a different set of social relations (Pickering 2010).
A study undertaken in rural Benin affirms the social significance of defecatory practices and latrines. The authors sought to challenge the notion that fear of infection and sickness was the main motivator for people to adopt latrines. Findings established that the strongest drives were prestige-related. People owning latrines were symbolic of revered people, similar to the ‘urban elite’: “In rural Benin, prestige or status conferred by latrine ownership comes from their symbolic ability to display an owner’s affiliation with the urban world…” (Jenkins & Curtis 2005: 2455).
Characteristics of CLTS facilitators and ‘triggerers’
At the very outset CLTS has incorporated participatory methods and conducted community sanitation assessments involving members from different levels of existing sanitation programmes (Kar 2003). These people came to be known as CLTS facilitators and “They were trained to focus on empowering all members of the community to analyse environmental conditions of the village” (Kar 2003: 4). Another method of empowering communities is based on CLTS facilitators’ identification of key people within the community to assume the role of ‘triggerer’.
In Nepal there are of four main levels of workers within the RWSSP-WN, consisting of: Administrative Project Level; District Water, Sanitation and Hygiene (WASH) advisors employed at district government level; CLTS Facilitators employed by local governments; and Triggerers who were trained by the CLTS facilitators to conduct ‘triggering’ exercises in the community. When I enquired about the characteristics of the people selected as triggerers, a project worker told me the following:
Yes they should have some special qualities… actually these are selected from the natural leaders… like natural leaders who come forward … and there are some individuals… since long time they are working with the community … and they can be the triggerers also because the community they already accepted those peoples…”
CLTS Facilitators work in close cooperation with the triggerers in targeted communities. The status already held by the triggerers facilitates the use of the sometimes harsh and confrontational techniques. As Kamal Kar pointed out CLTS facilitators don’t start using the word ‘shit’ (in Nepali ‘guhu’) from the outset. It is only after the community triggerers and other community members mention the local term that facilitators start using that word (Kamal Kar, personal communication, August 2012). I recall vividly being in a meeting with community members and asking them explicitly why they accepted people using harsh and confrontational language with them, one of the men in the group replied, and others affirmed what he said:
We accept it because we know they care about us.
CLTS facilitators coming from other places are taught by community members about the community sanitation profile that is built up during techniques such as transect walk, faecal mapping and faecal calculation. Kamal Kar asserts, during this process, the community are confronted with their defecation practices and are disgusted and ashamed by their own analysis. This triggers them into action (personal communication, August 2012).
Effectively this results in a process whereby members of targeted communities were encouraged to scrutinize their own sanitation conditions. Reports from Bangladesh describe the embarrassment felt by participating members of communities during the transect walk as they were accompanied by outside dignitaries (Kar & Pasteur 2005). As a result “They attempted to move the facilitators away from the area but the more they tried to move them on, the more they would stop and ask questions” (Kar 2003: 5). Despite the embarrassment, this did not backfire as one might expect, but rather resulted in meetings to discuss the problem (Kar & Pasteur 2005). This reflects on the sensitivity of CLTS facilitators, and would not have been possible without awareness and appreciation of local views and conditions. During a visit to Nepal in 2003 to specifically gain insight into the CLTS approach, WaterAid stressed that differences in caste, ethnicity, local customs and location need to be taken into consideration if CLTS projects are to succeed. They noted the role of good facilitators as agents of change and acknowledged the importance of local language in accelerating the internalization of sanitation and hygiene lessons (WaterAid 2006, in Budge 2010). A study undertaken in Ghana affirms this as they noted the importance of incorporating social-cultural preferences in the CLTS approach to sanitation (Wellington et al. 2011). Furthermore, they refer to the importance of community capital being tapped into as it aims to develop a sense of community pride.
An important dynamic takes place here, the ‘outsiders’ assume a passive, non-threatening role as ‘learners’ and community members are effectively the ‘teachers’ in this situation. However, learning also takes place for community members as they are confronted with the ‘power of their shit’.
This article asserts that CLTS techniques confront community members with the power of shit because the disgust it elicits is a stimulant for action that leads to a ‘cleaning up of the environment’. The defecation transect, the calculation flow and the glass of water, remove the anonymity of shit found in open spaces, kick cognitive gears into action regarding ingestion of shit and its contaminating powers. CLTS recognizes that the power lies not only in the physical contagion effects but also in the consequences of defecation practices for jeopardizing social relations. The validity of the theoretical explanations was apparent in both the literature and the case study, where numerous examples of issues related to disgust revealed the inherent disciplinary effect that is exerted when the anonymity and intimacy of this practice is removed and challenged. When using such harsh and potentially contentious techniques, it is important to recognise the value of these being community led techniques. The people implementing these techniques are well acquainted with the people they work with and familiar with the practice of OD; they understand the meaning of this practice and the factors that contribute to its persistence. They utilize this disciplinary agency of shit when attempting to prevent defecation in open public spaces. This disciplinary effect is harnessed, paradoxically, in an atmosphere of humour as well as social control. Disgust is profoundly social and not merely an intuitive, reflexive response. CLTS has realized this and harnesses the insight in its efforts to prevent the practice of Open Defecation.
Fiona Budge is a PhD student at the Athena Institute of the Vrije Universiteit of Amsterdam undertaking research into the mechanics of inclusion/exclusion practices. Spending more than twelve years, living and working, in lower-income countries stimulated her interest into how contextual influences contribute to the ways in which these practices emerge and persist and the role of disgust in these mechanisms. Email: email@example.com
Sjaak van der Geest has challenged my thinking, opened new doors of thought about perspectives on dirt and disgust, and particularly the meaning underlying many of the practices related to these concepts. Furthermore, this reflection would not have been possible without the guidance and assistance of RWSSP-WN staff; in particular Arto Suominen, Chhabi Goudel, Sangita Khadka and Eeva Maijala that helped me shed my culturally biased lenses and develop an appreciation for the processes at work in CLTS.
A special thanks to Dr. Harry Wels and Dr. Mariëtte van Amstel, your encouragement and wisdom pointed me in the right direction to pull these thoughts together. I am grateful to Sarah Cummings who stepped in to polish my writing with her valuable editing skills.
Almedom, A.M.1996 Recent developments in hygiene behaviour research: An emphasis on methods and meaning. Tropical Medicine & International Health 1 (2): 171-82.Angyal, A.1941 Disgust and related aversions. Journal of Abnormal & Social Psychology 36: 393-412.Beall, J. 2006 Dealing with dirt and the disorder of development: Managing rubbish in urban Pakistan. Oxford Development Studies 34 (1): 81-97.Budge, F. 2010 Health promotion efforts to prevent the practice of Open Defecation: How sensitive are health promoters to local views and conditions. (Unpublished Master's thesis). University of Amsterdam, Amsterdam. http://www.rwsspwn.org.np/wp-content/uploads/2012/05/Efforts-to-Prevent-The-Open-Defeacation-Practice.pdfChambers, R.2009 Going to scale with Community-Led Total Sanitation: Reflections on experience, issues and ways forward. Practice Paper, 1. Brighton: Institute of Development Studies, University of Sussex.Curtis, V. et al.1995 Potties, pits and pipes: Explaining hygiene behaviour in Burkina Faso. Social Science & Medicine 41 (3): 383-93.Curtis, V., M. Barra & R. Aunger2011 Disgust as an adaptive system for disease avoidance behaviour. Philosophical Transactions of the Royal Society: Biological Sciences 366 (1563): 389-401.Deak, A.2008 Taking Community-Led Total Sanitation to scale: Movement, spread and adaptation. Working Paper, 298. Brighton: Institute of Development Studies, University of Sussex.Douglas, M.1966 Purity and danger. London: Routledge & Kegan Paul.Fessler, D. & K. Haley2006 Guarding the perimeter: The outside-inside dichotomy in disgust and bodily experience. Cognition & Emotion 20 (1): 3-19.Jenkins, M.W.& V. Curtis2005 Achieving the 'good life': Why some people want latrines in rural Benin. Social Science & Medicine 61 (11): 2446-59.Kar, K.2003 Subsidy or self respect? Participatory total community sanitation in Bangladesh. Working Paper, 183. Brighton: Institute of Development Studies, University of Sussex.Kar, K. & P. Bongartz2006 Update on some recent developments in Community-Led Total Sanitation. Supplement to Working Paper 257. Brighton: Institute of Development Studies, University of Sussex.Kar, K. & K. Milward2011 Digging in, spreading out and growing up: Introducing CLTS in Africa. Practice Paper 8, Brighton: Institute of Development Studies, University of Sussex.Kar, K. & K. Pasteur2005 Subsidy or self-respect? Community led total sanitation. An update on recent developments. Supplement to Working Paper 257, Brighton: Institute of Development Studies, University of Sussex, http://www.ids.ac.uk/files/Wp257.pdf (Accessed Mar 2011).Kelly, P.2011 Yuck! The nature and moral significance of disgust. Cambridge, MA: MIT Press.Kolnai, A.2004 On disgust. Chicago and La Salle, Illinois: Open Court [German original 1929].Korsmeyer, C.2002 Delightful, delicious, disgusting. Journal of Aesthetics & Art Criticism 60 (3): 217-25.Kumar, N.K. & J.P. Shukla2008 Doing CLTS in a countrywide context in India: Public Good vs Private Good. Research Paper Ghaziabad: Knowledge Links.Lewis, M., J.M. Haviland-Jones & L. Feldman Barrett (eds)2008 Handbook of emotions. New York and London: The Guilford Press.Mahbub, A.2008 Social Dynamics of CLTS: Inclusion of Children, Women and Vulnerable. Paper for IDS Conference (draft version, unpublished).http://www.wsscc.org/sites/default/files/publications/plan_social_dynamics_of_clts_2008.pdf (Accessed Oct 2012).McGinn, C.2011 The meaning of disgust. Oxford: Oxford University Press.Menninghaus,W.2003 Disgust: Theory and history of a strong sensation. New York: State University of New York Press.Miller, S.2004 Disgust: The gatekeeper emotion. Hillside and London: Analytic Press.Miller, W.I.1997 The anatomy of disgust. Cambridge: Harvard University Press.Ortner, S.B.1973 Sherpa purity. American Anthropologist 75 (1): 49-63.Pickering, L.2010 Toilets, bodies, selves: Enacting composting as counterculture in Hawai'i. Body & Society 16 (4): 33-55.Plan Nepal2007 Evaluation of community led total sanitation. Kathmandu: Plan Nepal http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/cltshandbook.pdf.Rozin, P., J. Haidt & C.R. McCauley1987 A perspective on disgust. Psychological Review 94: 23-41.Van der Geest, S.2002 The night-soil collector: Bucket latrines in Ghana. Postcolonial Studies 5 (2): 197-206.2007 The social life of faeces: System in the dirt. In: R.S. van Ginkel & A. Strating (eds) Wildness and sensation: An anthropology of sinister and sensuous realms. Amsterdam: Het Spinhuis, pp. 381-91.Wellington, N.L., E. Larbi & J. Appiah2011 Innovative approaches to implementing CLTS in an urban setting: Successful lessons from piloting the approach in a small town of Lekpongunor in the Dangme West District of Ghana. Conference Paper. http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Urban_CLTS_Ghana.pdf (Accessed March 2012).