Toilet Training the Nation

This was the rather provocative title of a recent news article discussing the state of sanitation in the second of my worlds. An official from the Health Ministry is quoted as saying that as of 2010 some 42 million people in the country still defecated in the open. But this was down from 71 million in 2007 so they have made phenomenal progress in three short years (if the statistics are accurate).

Since people from the first of my worlds probably find that amazing and wonder what people do, let me hasten to explain that it is a timeless tradition in the tropics around the globe to use local streams, rivers, rice paddies, ditches or just a spot in the nearest banana patch or woods. It usually rains a lot and washes it all away, plus the strong tropical sun dries (and rots) things quickly. And where dogs and/or pigs run loose, well, they also help with, uh, waste disposal. Friends tell me of having to take a stick with them to keep the pigs away until they finished doing their “business”. People living by the sea just wade out a ways and go and the waves and tide will wash it away. The problem of course is that as the population grows, so does one's risk of catching a waterborn disease!

Even in the Mega City you can still sometimes see people using ditches and canals, especially children. Of course in big cities it’s easy to build a toilet without a septic tank, especially if you live along a main road with drainage canals beside them. You just run the “out” pipe into said ditch or even build a little hut over the ditch. Some people still use chamber pots or plastic bags and go empty them into the ditch after dark.

This is the goal

The article discusses that one of the biggest problems is changing people’s mindsets. Even if the government or some other agency builds them a toilet, some people will still not use it. When I first went to live among the No people many years ago there had already been a sanitation project where two squat-toilets with bathing area had been built for every 4 families, complete with concrete septic tank. The project  also put in wells with hand pumps near each toilet building. People liked having the wells but few of the toilets were actually being used. They said the problem was water.  Since you can't put in a well too near the septic tank or you may get contamination, they had to carry the water to flush the toilet. Not only that, they didn’t like keeping it clean (they said neighbor kids would use it and not flush and leave it a mess.) It was easier for them to do what they had always done – use the roadside irrigation ditch or an irrigation ditch out in the field. They felt it was “cleaner”.

Slowly over the next two decades though, most families in that No village did build a toilet in or next to their homes and nearly all now have their own well. In fact most have installed small electric pumps so they can more easily fill their concrete water tanks in the bathroom making it easy to bathe and flush toilets. Gone are the days of hiking a kilometer to the river with a dozen empty coconut shells to get drinking water! But even so, there are still a few die hard families who can’t be bothered to build a toilet and to this day, 2012,  continue defecating outside in a ditch. Unfortunately, even with toilets, many people still allow small children to relieve themselves anywhere. And there are always a few people who aren’t on the ball cleaning up the kids’ messes so you still do sometimes need to watch where you step.

In the article, a junior high boy was quoted as saying he’d rather have a satellite dish (for TV) than to have a toilet. That is not at all an uncommon attitude. I have been in many rural homes which have a TV, a motorcycle or two, sometimes even a satellite dish and a refrigerator, but not a toilet. The problem isn’t money, it’s a mind set.

Avastin

No, it's not a nautical term. It's a medicine used for retina problems. Monday (Feb 8) I had Avastin injected into my eye – and I have survived to tell about it! What follows is the gory details of the injection. If you do not like gory details just skip this post! But I am writing it for others who may someday need such an injection.

In early January I noticed an area of distortion in the upper left quadrant of one eye. At that point it was not in the macula and did not affect reading. But since I am very myopic I am at risk for retinal issues so went to see a local retina specialist.

I kept hoping the distortion in my right eye would get better with conservative treatment (anti inflammatory drops) but after a few weeks the area only got bigger. Once I decided to go for the anti-VEGF injection I went to the one and only doc in town who does it – and found out I’d have to wait another week because the Avastin would have to be ordered from the capital city. Although I wavered again and again over the next week, the area slowly got even bigger until I was totally unable to read a clock or calander or recognize faces with that eye . Reading a computer screen was slow and difficult even with enlargement, it was like looking through dirty water at italic and other weird shapes with piecs of the letters missing. And of course it is my dominent eye so it keeps trying to take over. By the time Monday came I was ready, if not exactly looking forward to it. The doc had ordered eye drops to start 4 days before the injection and an extremely (excessively?) high power antibiotic (Levofloxacin). Seemed a bit of over kill and after googling Levofloxacin I’m sure my fingers and feet started feeling numb!

Day 1 On Monday after lunch I went and got in line. They took me first so no chance to ask anybody else how it went. I was gratified that they used good aseptic technique, anesthesia drops, betadine drops and a presumably sterile face cloth with only a hole for the eye. The doctor put on some kind of head gear as well (I couldn’t see well with no glasses.) I was told to look off to the upper left. I am very nearsighted and couldn’t see much in the dim lighting but found a piece of shadow I tried to focus on. They put a gizmo to hold the eyelids open and did some more touching of the eye, none of which was painful. The injection itself wasn’t very painful but I saw the swirling of the medicine go in and lost the shadow I was trying to fix my eye on. I’m afraid my eye moved a little as I ended up with a good sized blood clot on the white of my eye. They patched the eye and gave me a list of instructions – eye drops every 2 hours for a week while awake, an anti-glaucoma drug the rest of today and tomorrow. Continue with the antibiotic for 5 more days. no bending, strenuous exercise or activity, no lifting heavy things, avoid sunlight and dust, close eyes while bathing for next week, and come back tomorrow. (The needle was nowhere as big as the drawing shows and was inserted on the outer side not the top.)

Total cost was $760 which I paid in cash after it was done. (And that was the cheaper procedeure. Lucentis would have been over $2100!)

I felt okay but it was weird having an eye patched, you kind of lose distance perspective like stepping off curbs, reaching for things, etc. The eye was starting to ache by the time I got home but the anti-glaucoma pill really seemed to help. I ended up taking the patch off because what with wearing glasses over it my eyelids kept brushing it and it was annoying. I did find a piece of clean gauze in my cupboard to cover it that first night. I could see as well as before the procedure but the blood did look kind of gross and I had to wipe some clots away that ran down after I put eye drops in.

Day 2 went okay, still taking the anti glaucoma drug and high power antibotic and eye drops every 2 hours. When I went back the doc said to not get my face wet in the shower (now he tells me!) but just clean with a cloth and to wash my hair like in a beauty parlor, not bent forwards. Sigh! Do you know how many times in a day a person bends over? Especially a tall person in a short man’s country?? I mean, books off of shelves, getting clothes out of cupboards, pans out of lower cabinets, lower desk drawers. I even have to get on my hands and knees to plug my computer in! That’s not to mention feeding the cats, or picking up things I drop, making bed, etc. Good things my knees are still good as I get lots of deep knee bends in these days! My eyes seemed tired and so I rested in the afternoon and went to bed a little earlier than usual.

Day 3 no more anti glaucoma med and so far so good, no aching. I got my hair washed today with assistance. We did at the outside sink. It was a bit messy and I had to change clothes afterwards but it’s great to have clean hair. It could be my imagination but the distorted area seems slightly clearer, I can read enlarged fonts through it, in a way it’s like having my own private magnifying glass LOL! Though still distorted. Faces are still not recognizable but I can see that it is a face, it’s not just all grayed out. And I can now see the center dot on the Amsler grid. I’m to go back in 2 weeks.

Day 4. Woke up feeling better. The bloody eye feels less sore. The possibly imagined slight improvement is still there. Wondering about this antibiotic tho. Something is giving me a head ache and making me feel kind of buzz-headed and spacey. It’s hopeless to do serious work. The bloody eye is getting slightly yellow around the edges (I can’t see cuz that eye still has the gray spot in the middle of whatever I look at but Maret helped me take a picture of it.)

Day 5 Still have a slight head ache. Wondering if it’s ok to stop the Levofloxacin a couple days early? Vision in right eye is dimmer than left. Used to be the other way around. Letters are also bigger in the right than the left. It’s been that way a long time, long before this bleed started. I CAN read with the right eye – it’s still dim and distorted but I CAN read. Interesting that in passages colored with colored pencil I can’t see the color. Hmmm. But I CAN read it. My eyes don’t work together yet, though so I still feel like things are kind of out of focus. I am going out to a meeting today so we shall see how I do!

Day 14 Went back to the doc today. I feel like the vision has improved significantly, tho not as to what it was before all this started. The line of print I read in a book or the screen is straight and clear tho the line above bows upward and the line below bows downward. I guess the distance acuity isn’t quite as sharp as it was as tho since I am not able to read all the letters on the chart. This doc is Dr Brevity. He kind of grunts and says “It’s flat”. Wondering if that’s good or bad I asked what was flat. He said the macula is flat that it had been swollen last time he saw it. I guess that’s good! But then he greases up the eye with lidocaine gel and sticks his scope in it and grunts again. Then goes off and writes a note to the referring doc and says it’ll happen again. (!?) He sees a scar, a black spot. There’s lattice degeneration and atrophy at 6 o’clock. I can go back to the referring doc in 2 weeks and she can laser it. So I am befuddled. Is this something new again? Why are we suddenly talking about laser??? His brevity doesn't help.

I have spent a lot of time on the internet and don’t find much. It seems no one has definitive answers to my questions such as why did this happen? How can I prevent a recurrence? Is exercise okay or not okay and what kind is bad? Anything but contact sports? Or as one doc said, only slow gentle stuff like walking and Tai Chi? And what about heavy lifting - like heavy bags when travelling and hauling water and washing clothes by hand in the village and hauling stuff on a motorbike? Certainly the three docs I have seem so far all had different opinions as to what was even wrong, let alone how to treat it or what if anything I could do to avoid future problems. Sigh!

On fragrant canals

Some things never change. Way back in 1971 John Perkins, the author of The Secret History Of The American Empire, went for his first stroll in the capital city of the second of my worlds. Here is his first impression:

...In an attempt to avoid being run over I nearly stepped into a gutter that was black as tar, littered with garbage, and reeking of urine.

The gutter drained down a steep incline to one of the many canals built by the Dutch during the colonial era. Now stagnant, its surface was covered with a green and putrid-looking scum; the stench that arose from it was nearly intolerable. It seemed preposterous that the inventive people who had turned the sea into farmland had attempted to recreate Amsterdam amid this tropical heat. The canal, like the gutter that fed it, overflowed with debris. I could even distinguish the two by their distinctive stenches. The gutter had an immediacy about its odor, rotting fruit and urine, while the canal carried a darker, longer-term pungency, the mixture of human excrement and decay.

I continued along, dodging the bicycle cabs that hugged the sides of the road. Beyond them, in the mainstream of the thoroughfare, was a frenzy of automobile and motorbike traffic; the sound of honking horns, backfiring engines, and muffler-deprived cars was overwhelming, as was the acrid stench of oil on hot pavement and gas fumes in the humid air. The weight of all this began to impact me physically.

Well said. He could write the exact same thing today in 2009.

Grossology

I heard about this new field of study just a couple of months ago. It is the study of all sorts of gross and disgusting things and things generally not spoken about in polite company. So if you are not into gross things, I would advise you to read no further - just skip down to the next post!

One very interesting cultural tidbit I picked up several years ago while living in a remote village was about farts. Farting is a universal phenomenon but is handled differently in different societies. Among the No people, farting is of course unavoidable but one must avoid farting near other people. You may be walking along with a group or even with just one other person and they will suddenly stop and leave you continuing down the trail by yourself – even in the midst of an exciting tale. If you notice and ask what the problem is, they will say they are farting.

Although it is considered somewhat of a social taboo to do it, they certainly have no trouble talking about it. In fact there are several different words for fart in the No language. The generic word is otu. This word is a noun but can be made into a verb, or even an adjective. You can add a prefix to the verb to make it mean ‘cause to fart’. You can add a different prefix to the adjective which comes out meaning ‘excessively farty’ (or something like that.) There even are a couple of idioms. One is to ‘eat other people’s farts’ which means to eat what’s left of a meal after everybody else has already eaten. Another is ‘fart on his words’ which means to dis what somebody said.

Then we have the word pudi. Now pudi is for quiet little high-pitched involuntary farts. Especially ones that squeeze out when you are trying very hard not to let them escape. I was told a folktale about a girl who did some pudi where it might have been overheard by a suitor. She was so embarassed and humiliated that she ended up killing herself. (I doubt that she was a No person, though.)

There is also the word poge. This is an explosively loud reverberating fart. One that absolutely cannot be hidden or blamed on the dog. You can’t do this one without loud protests from everybody in hearing range.

Now all these words can be combined with other verbs and adjectives to make very picturesque and graphic descriptions. For example, there is an adjective busi that usually means ‘very loud and startling and ground-shaking’ and is used to describe deafening noises such as a coconut suddenly whamming into a tin roof after falling from a tall tree, or something huge (like a giant tree) crashing to earth.

Well, one day the third grade class was left unsupervised while the teacher went up to his house to take care of something. While he was gone, the boys decided to have a farting contest. Of course each boy wanted to out fart the last one so things quickly ratcheted up. They began to cause-to-busi their farts. In other words, they put their hearts and souls into it. Jemy, forgetting that he had been having problems with diarrhea lately - yes, you can see where this one’s going. To hurry on with the story, Jemy ended up having to go home real early that day.

Poor Jemy. I will never forget the sight of him standing by the well while his 23 year-old uncle filled buckets of water to throw at him to get him cleaned up. Unfortunately his uncle was laughing so hard he could barely stand let alone pump coherently so the whole process took quite a while. Meanwhile his mother and aunts were pacing around spitting in disgust and muttering about kids who busiraka otu!

When they run out of the usual words, they can get very descriptive. (Now this next bit may get really gross – so I’m warning you to stop while you can!) For awhile I stayed in a very small house with several others. There was a bathroom off the kitchen with only a curtain for a door. One day someone was in there and obviously was having some major gas and stomach problems. He let out a tremendous and lengthy passage of gas and then made a loud remark about somebody revving up their motorcycle. I was in the next room trying to keep quiet but I noticed that everybody else dropped what they were doing and fled. When he finally came out there was nobody to be seen.

Wild bus rides

While in the second of my worlds last month, I travelled on a chartered bus 3 hours each way, up and over the mountains and down the coast a bit to a culture contest. It was one of those little busses designed in some industrialized Asian country that never made it in the home country and so was dumped on the market in a less fortunate country. It's the kind of vehicle that looks kind of cool on the outside, streamlined glass the whole length, but totally ignores passenger comfort on the inside. There were about six rows of seats, some so close together that even the tiny natives of this area were hard pressed to get their knees behind the seat in front of them. The little section of the window that actually could be opened was at about waist height - not very useful for anybody who was car sick or even just wanting a little air. As mentioned in my July post on Putting on a good face, the incidence of motion sickness in this area is VERY high.

To save my knees, I sat in the back seat by the door. There was 6 centimeters of space for my feet before the meter deep drop off into the stair well. An inexperienced rider would have been thrown off the seat into the stair well every time the driver braked, which on the narrow, twisting road was quite often.

Soon after beginning the climb up into the mountains the bus got very quiet. The only thing you could hear was the "kkkkkkkkkhhh!" of people clearing the backs of their throats trying frantically not to vomit. People were soon vying for plastic bags and taking turns standing in the stairwell so they could get air or at least barf out the door. The driver's assistant had left the door open but had helpfully put a grab bar across the opening which later on was very helpful to those so overcome by nausea they barely had the strength to stand. One guy would hang his head out the door hugging the door because he was so sick. I was afraid he would get whacked by a tree branch or even lose his grip and fall out. I decided then and there to NEVER pass a bus on the shoulder.

When we arrived back in the village people quietly got off the bus, some immediately squatted down at the side of the road, others lay flat on the floor of the nearest structure. Those who could still walk gathered their things and went quietly home. Those who had remained by the side of the road were all recovered by the next afternoon.

I am very grateful that I do not get car sick. They joke about it but it can truly be a terrible thing.

Putting on a good face

This first story probably falls in the category of gross, but clearly demonstrates the universal tendancy for people to want to put on a good face.

In this neck of southeast Asia, roads are not usually straight, even on flat ground. When going up in the mountains this is even more true because in addition to the uneven surface you now have curves too tight for big busses, plus potholes, cracks, gulleys, and residue from landslides to maneuvre around. Added to this is the fact that there is a HIGH tendancy in the local population towards motion sickness. Need I say more? Anyway, one day Udin was riding on a minibus and was seated next to a very attractive young lady. Imagine Udin's anxiety when he began to get carsick. I mean REALLY carsick. What to do? Well, Udin came up with a most face-saving solution - he swallowed it again. Neat, huh? No fuss, no mess. The attractive girl never knew.