India Public Hygiene Worst in the World

India's rivers have been turned into open sewers by 638 million Indians without access to toilets, according to rural development minister Jairam Ramesh. He was reacting a UNICEF report that says Indians make up 58% of the world population which still practices open defection, and the sense of public hygiene in India is the worst in South Asia and the world.



India(638m) is followed by Indonesia (58m), China (50m), Ethiopia (49m), Pakistan (48m), Nigeria (33m) and Sudan (17m). In terms of percentage of each country's population resorting to the unhygienic practice, Ethiopia tops the list with 60%, followed by India 54%, Nepal 50%, Pakistan 28%, Indonesia 26%, and China 4%.

18 percent of urban India still defecates in open while the percentage of rural India is as high as 69 percent of the population. It is the key reason why India carries among the highest infectious disease burdens in the world.

The number of open defecators in rural India alone is more than twice those in the whole of sub-Saharan Africa, according to a report by DFID, the UK's Department for International Development.

The World Bank has estimated that open defecation costs India $54 billion per year or $48 per head. This is more than the Government of India’s entire budget for health.

The UNICEF report says that with only four more years to go until 2015, a major leap in efforts and investments in sanitation is needed to reach the targets of Millennium Development Goals.

After the embarrassing headlines, it appears that Minister Ramesh is ready to step up the efforts to improve sanitation. He is quoted by Times of India as saying that "we are going to focus now on `nirmal gram abhiyan' -- today 25,000 nirmal grams are a tiny fraction of 6 lakh villages. These nirmal grams are in Maharashtra and Haryana. Maharashtra is a success of social movements while Haryana an example of determined state government action."

Here's a video clip of Indian environment minister Jairam Ramesh saying "if there was a Nobel Prize for dirt and filth, India would win it hands down":




Related Links:

Haq's Musings

Fixing Sanitation Crisis in India

Food, Clothing and Shelter in India and Pakistan

Heavy Disease Burdens in South Asia

Peepli Live Destroys Indian Myths

India After 63 Years of Independence

Poverty Across India 2011

India and Pakistan Contrasted

Comments

Riaz Haq said…
Here's the story of two Indias by World Bank's managing director Dr. Ngozi Okonjo-Iweala:

India’s global profile is rising—from a slow-growing poor country to a burgeoning economic power:

· India grew fast before the crisis--9% per year--and has resumed fast growth--8.6% in the fiscal year that ended in March.

· India is globally recognized as a key player in the IT revolution, and in sectors as diverse as pharmaceutical, cement, steel and space
---------
But there is also another India:

· India’s GNI per capita ($1170) is lower than that of 161 other countries. World Bank’s poverty numbers show 456 million people in India are poor—about one-third of the world’s poor, and more than in all of Sub-Saharan Africa.

· India lags significantly on health and nutrition targets: It is home to half of world’s underweight children, and it accounts for 1 in 5 maternal and child deaths worldwide.

· Social exclusion remains a stark reality—Scheduled Tribes lag twenty years behind the general population, Scheduled Castes ten years; gender norms can be quite restrictive and gender gap persists in realms such as child mortality and labor force participation.
The 9% growth hides an infrastructure crisis. Innovation in the private sector has often got around this—60% of firms and a large percentage of homes rely on back-up generation, and on an industry of logistical firms. But this has costs, and sooner or later infrastructure constraints will bite, and growth will slow, absent major change. This is especially true in urban areas.
PPPs are often hailed as a solution. Private participation in infrastructure took off in the early 1990s in telecoms and power supply. Highway, port, and airport concessions began to emerge in the late 1990s, with water supply and solid waste management following. We have been here before. In the 1990s Latin America had major infrastructural gaps, and PPPs were thought to be the solution (including by the World Bank). But gaps were effectively closed only in telecoms (which was not an issue for India) and in Chile (a small country with by far the best governance to manage private sector involvement). Elsewhere, there was insufficient private involvement, or private involvement that was high cost, often corrupt, and with frequent renegotiation to extract better deals from the state and society.

The lesson is that improving governance, and solving institutional problems, is unavoidable to improve infrastructure provision, and is necessary for effective private involvement.

The challenge here is so well-known that I do not need to dwell on it much. India has enormous untapped potential—productivity in Eastern states, for instance, is well below what it is in Punjab, and sustainability is an issue in states like Punjab.
-----------
V. Education: Focus on results, not inputs

The two Indias are very visible in education: Graduates of India's famed Institutes of Technology literally drive growth. But basic and secondary education are dismal. In fact, even in tertiary education quality is in islands of excellence, not widespread. The demographic dividend can turn into a demographic curse if the millions of young people entering the labor market every year are not equipped to take up the jobs that a fast-growing economy can create...
Riaz Haq said…
Here are some excerpts from an NPR interview of Siddhartha Deb, the author of "The Beautiful and The Damned":

......
DEB: Well, I was interested in the changes that were happening there. Obviously, it's a lot of people experiencing change in new ways, in some sense, and I had gotten the impression that there was a very triumphalist version of this change, which is that the country is doing very well.

There was even a slogan that was coined by one of the political parties. It was called India Shining. And I was going back. I was writing feature articles. I was a freelance writer. And I was somewhat skeptical of this. It was pretty obvious that at the upper levels people were much better off materially than they had been in the past.

But certainly large numbers or swaths of people seem to be untouched or mired in the same poverty, or sometimes even worse because they could now see this incredible contrast. So I wanted to examine that. I wanted to do that by checking, by looking at the new rich. I wanted to look at people who were in the middle, people who were middle class.
----------

DONVAN: Well, and the style in which the book is written still reads like a novel. It is full of color and texture and even sights and sounds and smells.

DEB: Thank you. That was very much the intention, to write something like a nonfiction novel, if that's possible. So the facts aren't made up, they're very scrupulously researched. I've tried to be as accurate as possible, but I wanted the texture, the flavor of a novel, of people in motion in some sense.

DONVAN: Can I say that the story that you've written reads to me as a very sad story?

DEB: That would be - that's a fairly, I think, reasonable, actually, interpretation. I think it's a sad story to me too, in many ways.

DONVAN: Even among those who feel that you describe - you describe an engineer named Chuck who is building a house. He had lived in the United States, and he's now building a house in the American model. He gives you a tour. He even uses American language. This is the open-plan kitchen, this is the master bedroom.

And yet you portray him as - his desires as being somewhat hollow, as though he's not a happy man himself.

DEB: Well, I mean, I think Chuck would see himself as a happy man, and I think that's reasonable. I've tried to allow people that space. But yes, I as a narrator come in, and I do sometimes question what some of my characters are saying.

So when someone like Chuck says, you know, he did say this, that there are these incredible contrasts in India, but that's okay, we're kind of one big happy family, and I question whether that's really the case, when, you know, you have at the very top end of the country, say you have, say, something like 66 billionaires.

And these numbers might be slightly old, but there are probably a few more billionaires since I last checked. But 66 billionaires who seem to have something like 30 percent of the country's wealth.

On the other end, you have like 800 million people, over 800 million people living on less than $2 a day. When you have a country where 40 percent of the children under the age of five suffer from malnutrition, it seems to me that these contrasts aren't really healthy. They're not just differences. They are really like living different worlds within the same country.

So yes, I actually come in as a narrator, and I question when, say, Chuck is a character, he sees his life as striving and successful. And I think that's reasonable, again, but I also question the fact that this house, this special zone in which the house is constructed, is being built on what is a demolished village, and I have very hard questions......


http://www.npr.org/templates/transcript/transcript.php?storyId=141213308
Riaz Haq said…
Here's Razib Khan of Brown Pundits on Washington Post's piece about "demographic dividend" in India:

"Amid population boom, India hopes for ‘demographic dividend’ but fears disaster. The article is OK, but I feel as usual it doesn’t do a good enough job highlighting the huge variation in fertility across India the nation-state. Tamil Nadu has the fertility of Northern Europe while Uttar Pradesh is like West Africa. Unfortunately the “demographic dividend” is going be driven by the most backward and unproductive regions of the nation on a per unit basis…."

http://www.brownpundits.com/2011/10/15/indias-demographic-dividend-and-despair/

http://www.washingtonpost.com/world/asia_pacific/amid-population-boom-india-hopes-for-demographic-dividend-but-fears-disaster/2011/10/12/gIQA9I4nmL_story.html
Riaz Haq said…
Here's a Reuters' piece on absence of hygiene in India:

My Indian friends and I joke around a lot about me as the typical white American guy visiting India. Cows! Con men! Colors! Most people I’ve met in India have restricted their reactions to my westerner-in-the-east experiences to gentle teasing. When I stuck a picture of a man urinating in public on my Facebook page, calling it one more picture of what you see everywhere you go in India, people weren’t as patient. What was I doing? Insulting the nation? Focusing on the ugly because it’s what all the westerners do when they visit India? Why does India provoke such visceral reactions in visitors?

Public urination, public defecation, dirt, garbage, filth, the poor living on the street — talking about these things, even acknowledging that they’re in front of your face, risks making your hosts unhappy, and possibly angry. It’s the third rail of India, and the voltage can be lethal. That’s why I was surprised when B.S. Raghavan decided to touch it with all 10 fingers.

Raghavan’s column in The Hindu Business Line newspaper begins with this headline: Are Indians by nature unhygienic?

Consider these excerpts:

From time to time, in their unguarded moments, highly placed persons in advanced industrial countries have burst out against Indians for being filthy and dirty in their ways of life. A majority of visitors to India from those countries complain of “Delhi belly” within a few hours of arrival, and some fall seriously ill.

There is no point in getting infuriated or defensive about this. The general lack of cleanliness and hygiene hits the eye wherever one goes in India — hotels, hospitals, households, work places, railway trains, airplanes and, yes, temples. Indians think nothing of spitting whenever they like and wherever they choose, and living in surroundings which they themselves make unliveable by their dirty habits. …

Open defecation has become so rooted in India that even when toilet facilities are provided, the spaces round temple complexes, temple tanks, beaches, parks, pavements, and indeed, any open area are covered with faecal matter. …

Even as Indians, we are forced to recoil with horror at the infinite tolerance of fellow Indians to pile-ups of garbage, overflowing sewage, open drains and generally foul-smelling environs.

There’s plenty more that you can read in that story, but I’ll direct you to the article. I’ll also ask you some questions:

Some people say you shouldn’t point out these problems, and that every country has problems. Do you agree with this statement? Why?
Does anyone disagree with Raghavan’s descriptions of these sights and smells?
Is this even a problem? Or should people get used to it?
Should visitors, especially ones from countries where people are generally wealthier, say nothing, and pretend that they don’t see unpleasant things?

As for me, I can say this: I got used to it, but I would be lying if I said I didn’t notice it. Indians notice it too. Otherwise, people wouldn’t suggest public shaming campaigns against people urinating in public, they wouldn’t threaten fines for doing it, and they wouldn’t respond with relief to plans to finally make sure that toilets on India’s trains don’t open directly onto the tracks. Of course, these are people in India. It’s a family, taking care of business the family way.

As for me, the message usually seems to be: “If you don’t love it, leave it.” It would be nice if there were some other answer. Acknowledging problems, even ones that are almost impossible to solve, makes them easier to confront.

http://blogs.reuters.com/india/2012/11/17/indians-inherently-unhygienic-indian-writer-touches-third-rail/
Riaz Haq said…
Here's a Reuters' blog post on lack of hygiene in India:

My Indian friends and I joke around a lot about me as the typical white American guy visiting India. Cows! Con men! Colors! Most people I’ve met in India have restricted their reactions to my westerner-in-the-east experiences to gentle teasing. When I stuck a picture of a man urinating in public on my Facebook page, calling it one more picture of what you see everywhere you go in India, people weren’t as patient. What was I doing? Insulting the nation? Focusing on the ugly because it’s what all the westerners do when they visit India? Why does India provoke such visceral reactions in visitors?

Public urination, public defecation, dirt, garbage, filth, the poor living on the street — talking about these things, even acknowledging that they’re in front of your face, risks making your hosts unhappy, and possibly angry. It’s the third rail of India, and the voltage can be lethal. That’s why I was surprised when B.S. Raghavan decided to touch it with all 10 fingers.

Raghavan’s column in The Hindu Business Line newspaper begins with this headline: Are Indians by nature unhygienic?

Consider these excerpts:

From time to time, in their unguarded moments, highly placed persons in advanced industrial countries have burst out against Indians for being filthy and dirty in their ways of life. A majority of visitors to India from those countries complain of “Delhi belly” within a few hours of arrival, and some fall seriously ill.

There is no point in getting infuriated or defensive about this. The general lack of cleanliness and hygiene hits the eye wherever one goes in India — hotels, hospitals, households, work places, railway trains, airplanes and, yes, temples. Indians think nothing of spitting whenever they like and wherever they choose, and living in surroundings which they themselves make unliveable by their dirty habits. …

Open defecation has become so rooted in India that even when toilet facilities are provided, the spaces round temple complexes, temple tanks, beaches, parks, pavements, and indeed, any open area are covered with faecal matter. …

Even as Indians, we are forced to recoil with horror at the infinite tolerance of fellow Indians to pile-ups of garbage, overflowing sewage, open drains and generally foul-smelling environs.

There’s plenty more that you can read in that story, but I’ll direct you to the article. I’ll also ask you some questions:

Some people say you shouldn’t point out these problems, and that every country has problems. Do you agree with this statement? Why?
Does anyone disagree with Raghavan’s descriptions of these sights and smells?
Is this even a problem? Or should people get used to it?
Should visitors, especially ones from countries where people are generally wealthier, say nothing, and pretend that they don’t see unpleasant things?
As for me, I can say this: I got used to it, but I would be lying if I said I didn’t notice it. Indians notice it too. Otherwise, people wouldn’t suggest public shaming campaigns against people urinating in public, they wouldn’t threaten fines for doing it, and they wouldn’t respond with relief to plans to finally make sure that toilets on India’s trains don’t open directly onto the tracks. Of course, these are people in India. It’s a family, taking care of business the family way.

As for me, the message usually seems to be: “If you don’t love it, leave it.” It would be nice if there were some other answer. Acknowledging problems, even ones that are almost impossible to solve, makes them easier to confront.


http://blogs.reuters.com/india/2012/11/17/indians-inherently-unhygienic-indian-writer-touches-third-rail/
Riaz Haq said…
Here's a Time magazine story of a finding that Indian children's exceptionally short heights are attributable to poor sanitation in India, not malnutrition:

Children in India are exceptionally short, with their stunted growth historically attributed to malnutrition. However, new evidence is suggesting that food, or lack of it, is not the cause. Noticing that Indian children were smaller than their counterparts in Sub-Saharan Africa — who are, on average, poorer and hence less well fed — researchers have been coming to the conclusion that diseases stemming from poor sanitation are more to blame than diet.

More than half of India’s population — over 600 million people — do not use a toilet because sanitation is inaccessible or unaffordable. At the same time 61.7 million Indian children are stunted, the highest prevalence in the world.

The atrocious hygiene that results from widespread lack of sanitation is made worse by the density of the population. With large numbers of people openly defecating, fecal-oral-transmitted infections are common, leading to diarrhea, with such diseases draining growing children of vital nutrients. Growing up in environments teeming with fecal pathogens has a permanently debilitating effect, experts say. Overtime, a large build-up of fecal germs in the body can also manifest as severe intestinal diseases.

Last month, a group of economists, epidemiologists, pediatricians and nutritionists gathered at a conference in New Delhi to push for recognition of poor sanitation as the cause of child stunting in India. “It was striking that each of them [participants] had something to say about sanitation being important for child health,” Sangita Vyas, of the Research Institute for Compassionate Economics, which coorganized the meeting, told TIME. Such claims emerge at a time when the results of a massive government survey into the availability of sanitation have become available and converged with long-standing epidemiological literature.

Rural Indians remain hard to convince that this is a health epidemic, researchers say, because stunting creeps through communities, affects “everybody on average” and there are “no real dramatic cases,” Princeton University economist Dean Spears, who is currently at the Delhi School of Economics, told TIME. “The sorts of dramatic tragedies that persuade people [to change] don’t happen,” he says.

(MORE: Are Toilets a Feminist Issue? Why the Burden of Bad Sanitation Falls on Women)

A few years ago, a government sanitation program was implemented in half of 60 villages in Ahmednagar, Maharashtra, Western India. After the program, Spears and fellow economist Jeff Hammer found on average, that the height of children in the experimental group had increased by about one centimeter, relative to those in the 30 villages where the program had not been introduced.

“Widespread child-stunting in India is a human development emergency,” Spears says. “It matters for everybody.”


http://world.time.com/2013/09/09/poor-sanitation-not-malnutrition-may-be-to-blame-for-indias-notoriously-stunted-children/
Riaz Haq said…
Here's a NY Times report on salmonella contamination of Indian spices exported to US:

...The United States Food and Drug Administration will soon release a comprehensive analysis that pinpoints imported spices, found in just about every kitchen in the Western world, as a surprisingly potent source of salmonella poisoning.

In a study of more than 20,000 food shipments, the food agency found that nearly 7 percent of spice lots were contaminated with salmonella, twice the average of all other imported foods. Some 15 percent of coriander and 12 percent of oregano and basil shipments were contaminated, with high contamination levels also found in sesame seeds, curry powder and cumin. Four percent of black pepper shipments were contaminated.

Each year, 1.2 million people in the United States become sick from salmonella, one of the most common causes of food-borne illness. More than 23,000 are hospitalized and 450 die. Symptoms include diarrhea, fever and abdominal cramps that begin 12 to 36 hours after infection and can last three to five days. Death can result when infection spreads from the intestines to the bloodstream and affects vital organs. Infants and older people are most at risk.

Mexico and India had the highest share of contaminated spices. About 14 percent of the samples from Mexico contained salmonella, the study found, a result Mexican officials disputed.

India’s exports were the second-most contaminated, at approximately 9 percent, but India ships nearly four times the amount of spices to the United States that Mexico does, so its contamination problems are particularly worrisome, officials said. Nearly one-quarter of the spices, oils and food colorings used in the United States comes from India.

The findings, the result of a three-year study that F.D.A. officials have on occasion discussed publicly and recently published in the journal Food Microbiology, form an important part of the spice analysis that will be made public “soon,” agency officials said.

“Salmonella is a widespread problem with respect to imported spices,” Michael Taylor, deputy F.D.A. commissioner for food, said in an interview. “We have decided that spices are one of the significant issues we need to be addressing right now.”

Westerners are particularly vulnerable to contaminated spices because pepper and other spices are added at the table, so bacterial hitchhikers are consumed live and unharmed. Bacteria do not survive high temperatures, so contaminated spices present fewer problems when added during cooking, as is typical in the cuisine of India and most other Asian countries.
-------------
Salmonella can survive indefinitely on dried spices, and killing the bacterium on the craggy surface of dried peppercorns without ruining their taste is especially challenging.

Government officials in India emphasized in interviews that spices slated for export are often treated to kill any bacteria. Such treatments include steam-heating, irradiation or ethylene oxide gas. But F.D.A. inspectors have found high levels of salmonella contamination in shipments said to have received such treatments, documents show. Much of the contaminated pepper in the 2010 outbreak had been treated with steam and ethylene oxide and had been certified as tested and safe, officials said.

At another spice farm, in the village of Chemmanar, Bipin Sebastian is in the midst of a four-year transition to organic farming in hope of earning a premium price for his pepper, cloves, cardamom, turmeric and coffee. Mr. Sebastian says he has used government subsidies to buy tarps, netting and a machine thresher.

“We used to put our pepper directly on the ground,” Mr. Sebastian said. “Now, we put down tarps and netting over it to protect it from the birds. And I’ve been getting a higher price. It’s been great.”


http://www.nytimes.com/2013/08/28/world/asia/farmers-change-over-spices-link-to-food-ills.html
Riaz Haq said…
@UNICEFIndia Is Inviting #India to a Poo Party #IndiaElections #Sanitation #hygiene #Toilettes https://news.vice.com/articles/unicef-is-inviting-india-to-a-poo-party … via @vicenews
Riaz Haq said…
NY Times: India's malnutrition and stunting due to poor sanitation.


SHEOHAR DISTRICT, India — He wore thick black eyeliner to ward off the evil eye, but Vivek, a tiny 1-year-old living in a village of mud huts and diminutive people, had nonetheless fallen victim to India’s great scourge of malnutrition.

His parents seemed to be doing all the right things. His mother still breast-fed him. His family had six goats, access to fresh buffalo milk and a hut filled with hundreds of pounds of wheat and potatoes. The economy of the state where he lives has for years grown faster than almost any other. His mother said she fed him as much as he would eat and took him four times to doctors, who diagnosed malnutrition. Just before Vivek was born in this green landscape of small plots and grazing water buffalo near the Nepali border, the family even got electricity.

So why was Vivek malnourished?

It is a question being asked about children across India, where a long economic boom has done little to reduce the vast number of children who are malnourished and stunted, leaving them with mental and physical deficits that will haunt them their entire lives. Now, an emerging body of scientific studies suggest that Vivek and many of the 162 million other children under the age of 5 in the world who are malnourished are suffering less a lack of food than poor sanitation.

Two years ago, Unicef, the World Health Organization and the World Bank released a major report on child malnutrition that focused entirely on a lack of food. Sanitation was not mentioned. Now, Unicef officials and those from other major charitable organizations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problems.

“Our realization about the connection between stunting and sanitation is just emerging,” said Sue Coates, chief of water, sanitation and hygiene at Unicef India. “At this point, it is still just an hypothesis, but it is an incredibly exciting and important one because of its potential impact.”

This research has quietly swept through many of the world’s nutrition and donor organizations in part because it resolves a great mystery: Why are Indian children so much more malnourished than their poorer counterparts in sub-Saharan Africa?

A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the planet’s poorest countries. Stunting affects 65 million Indian children under the age of 5, including a third of children from the country’s richest families.....
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No Indian city has a comprehensive waste treatment system, and most Indian rivers are open sewers as a result. But Varanasi, India’s oldest and holiest city, is so awash in human waste that its decrepit condition became a national issue in recent elections. The city’s sewage plants can handle only about 20 percent of the sewage generated in the city, said Ramesh Chopra of Ganga Seva Abhiyanam, a trust for cleaning the river. The rest sloshes into the Ganges or fetid ponds and pits.

Millions of pilgrims bathe in the Ganges along Varanasi’s ancient riverfront, but a stream of human waste — nearly 75 million liters per day — flows directly into the river just above the bathing ghats, steps leading down to the river. Many people wash or brush their teeth beside smaller sewage outlets.

Much of the city’s drinking water comes from the river, and half of Indian households drink from contaminated supplies.

“India’s problems are bigger than just open defecation and a lack of toilets,” Dr. Laxminarayan said.


http://www.nytimes.com/2014/07/15/world/asia/poor-sanitation-in-india-may-afflict-well-fed-children-with-malnutrition.html?_r=0
Riaz Haq said…
#India: inherently unhygienic? #Indian writer touches third rail http://reut.rs/1pa6d7h via @Reuters

My Indian friends and I joke around a lot about me as the typical white American guy visiting India. Cows! Con men! Colors! Most people I’ve met in India have restricted their reactions to my westerner-in-the-east experiences to gentle teasing. When I stuck a picture of a man urinating in public on my Facebook page, calling it one more picture of what you see everywhere you go in India, people weren’t as patient. What was I doing? Insulting the nation? Focusing on the ugly because it’s what all the westerners do when they visit India? Why does India provoke such visceral reactions in visitors?

Public urination, public defecation, dirt, garbage, filth, the poor living on the street — talking about these things, even acknowledging that they’re in front of your face, risks making your hosts unhappy, and possibly angry. It’s the third rail of India, and the voltage can be lethal. That’s why I was surprised when B.S. Raghavan decided to touch it with all 10 fingers.

Raghavan’s column in The Hindu Business Line newspaper begins with this headline: Are Indians by nature unhygienic?

Consider these excerpts:

From time to time, in their unguarded moments, highly placed persons in advanced industrial countries have burst out against Indians for being filthy and dirty in their ways of life. A majority of visitors to India from those countries complain of “Delhi belly” within a few hours of arrival, and some fall seriously ill.

There is no point in getting infuriated or defensive about this. The general lack of cleanliness and hygiene hits the eye wherever one goes in India — hotels, hospitals, households, work places, railway trains, airplanes and, yes, temples. Indians think nothing of spitting whenever they like and wherever they choose, and living in surroundings which they themselves make unliveable by their dirty habits. …

Open defecation has become so rooted in India that even when toilet facilities are provided, the spaces round temple complexes, temple tanks, beaches, parks, pavements, and indeed, any open area are covered with faecal matter. …

Even as Indians, we are forced to recoil with horror at the infinite tolerance of fellow Indians to pile-ups of garbage, overflowing sewage, open drains and generally foul-smelling environs.

There’s plenty more that you can read in that story, but I’ll direct you to the article. I’ll also ask you some questions:

Some people say you shouldn’t point out these problems, and that every country has problems. Do you agree with this statement? Why?
Does anyone disagree with Raghavan’s descriptions of these sights and smells?
Is this even a problem? Or should people get used to it?
Should visitors, especially ones from countries where people are generally wealthier, say nothing, and pretend that they don’t see unpleasant things?
As for me, I can say this: I got used to it, but I would be lying if I said I didn’t notice it. Indians notice it too. Otherwise, people wouldn’t suggest public shaming campaigns against people urinating in public, they wouldn’t threaten fines for doing it, and they wouldn’t respond with relief to plans to finally make sure that toilets on India’s trains don’t open directly onto the tracks. Of course, these are people in India. It’s a family, taking care of business the family way.

As for me, the message usually seems to be: “If you don’t love it, leave it.” It would be nice if there were some other answer. Acknowledging problems, even ones that are almost impossible to solve, makes them easier to confront.
Riaz Haq said…
Holding Your Breath in #India #pollution http://nyti.ms/1eCMCxj by Gardiner Harris in New Delhi fir NY Times

We gradually learned that Delhi’s true menace came from its air, water, food and flies. These perils sicken, disable and kill millions in India annually, making for one of the worst public health disasters in the world. Delhi, we discovered, is quietly suffering from a dire pediatric respiratory crisis, with a recent study showing that nearly half of the city’s 4.4 million schoolchildren have irreversible lung damage from the poisonous air.
------------
And children are by no means the only ones harmed. Many adults suffer near-constant headaches, sore throats, coughs and fatigue. Arvind Kejriwal, Delhi’s chief minister, had to leave the city for 10 days in March to cure a chronic cough.

It’s not just the air that inflicts harm. At least 600 million Indians, half the total population, defecate outdoors, and most of the effluent, even from toilets, is dumped untreated into rivers and streams. Still, I never thought this would come home to my family quite as dramatically as it did.

We live in a four-year-old, five-story apartment building that my wife chose because its relatively new windows could help shut out Delhi’s appalling nighttime air. Its cookie-cutter design — by the same developer who built dozens of others in the neighborhood — gave us confidence that things would function, by no means assured for new construction here.

About six months after we moved in, one of our neighbors reported that her tap water suddenly smelled like sewage. Then the smell hit another neighbor and another. It turned out that the developer had dug open channels for sewage that had gradually seeped into each apartment’s buried water tank. When we pulled up the floor tiles on the ground floor, brown sludge seemed to be everywhere.

I was in the shower when this sewage mixture arrived in our apartment. Sounds horrible, but I shrugged and toweled off because that smell is such a frequent presence here.

For much of the year, the Yamuna River would have almost no flow through Delhi if not for raw sewage. Add in the packs of stray dogs, monkeys and cattle even in urban areas, and fresh excretions are nearly ubiquitous. Insects alight on these excretions and then on people or their food, sickening them.


Most piped water here is contaminated. Poor sanitation may be a crucial reason nearly half of India’s children are stunted.

The list of health threats sounds harrowing when considered together, but life goes on and can be quite nice here. Our apartment building eventually installed aboveground water tanks. My children’s school and travel in the region are terrific, and many expats are far more influential here than they would be in their home countries.

Yet one afternoon this spring, someone in our neighborhood burned something toxic, and an astringent cloud spread around our block. My wife was out walking with a friend, and their eyes became teary and their throats began to close. They bolted back inside our apartment where they found Bram gasping again, for the first time in two years. In some places in Delhi, the levels of fine particles that cause the most lung damage, called PM2.5, routinely exceed 1,000 in winter in part because small trash and other fires are so common, according to scientists. In Beijing, PM2.5 levels that exceed 500 make international headlines; here, levels twice that high are largely ignored.

http://www.nytimes.com/2015/05/31/opinion/sunday/holding-your-breath-in-india.html?_r=0
Riaz Haq said…
UNICEF: In spite of #Modi's "Clean India" campaign, #India Lags Behind #Pakistan, #Nepal on Sanitation http://on.wsj.com/1INbqKI via @WSJIndia

Indian Prime Minister Narendra Modi has made sanitation a priority for his country, saying he would rather build toilets than temples and setting a goal for every home in the country to have a place to go to the bathroom by 2019.

But new data show India is lagging behind its neighbors in providing access to adequate sanitation.

“Progress on Sanitation and Drinking Water,” a report published by the United Nations Children’s Fund and the World Health Organization this week, says that advancements in meeting Millennium Development Goals, or MDGs, by 2015 in relation to sanitation have faltered worldwide. The report says 2.4 billion people still don’t have access to improved sanitation.

Mr. Modi launched his Clean India, or Swachh Bharat, campaign last year for good reason. Research shows that the practice of open defecation is linked to a higher risk of stunting in children and the spread of disease. A World Health Organization report said in 2014 that 597 million people in India still relieved themselves outdoors. And the new WHO/Unicef report says that the Southern Asia region has the highest number of people who defecate in the open.

The new data show that despite recent efforts, over the past 25 years, India has been losing the regional race to improve sanitation.

Its neighbors, Nepal, Bangladesh and Pakistan led the way with the greatest percentage-point change in the proportion of the population with access to improved sanitation facilities between 1990 and 2015.

Pakistan’s percentage point change was 40–64% of people have use an improved sanitation facility. In Nepal, a country in which just 4% of people had access to improved sanitation facilities in 1990, access rose by 42 percentage points to 46%. Bangladesh improved its score by 27 percentage points — 61% now have access to improved sanitation facilities.

India meanwhile, had a lower 23 percentage point increase in the same period – bringing the number of people with access to improved sanitation facilities to 40%.

And Sri Lanka is way ahead, with 95% of people having access to improved sanitation.

The report defines an improved sanitation facility as one that hygienically separates excreta from human contact and the target was for 50% or more of those with inadequate water or sanitation in 1990 to have adequate sanitary services in 2015.

Likewise, rates of open defecation have reduced, but India still has the highest percentage of the population defecating in the open–with 44% of people going outside in 2015—down from 75% in 1990, compared with a 13% figure for Pakistan in 2015, 32% for Nepal and only 1% for Bangladesh.

But, the report says: “The 31 per cent reduction in open defecation in India alone represents 394 million people, and significantly influences regional and global estimates.”
Riaz Haq said…
Jharkhand, #India: Girl commits suicide after parents refuse toilet in home

http://www.hindustantimes.com/india-news/girl-kills-self-in-jharkhand-after-parents-refuse-toilet-in-home/article1-1365606.aspx via @htTweets

A class 12 student allegedly committed suicide on Friday in Jharkhand’s Dumka district after her parents turned down her repeated pleas to construct a toilet at home as they wanted to save money for the 17-year-old’s marriage, police said.

Khushbu Kumari, a resident of Dudhani colony in the town, was found hanging from the ceiling of her room by family members, the police added.

The tragedy underlined a growing awareness on hygiene among the younger generation in the state which has country’s highest rate of open defecation.

The 2011 census had said that 92.4% people in Jharkhand’s rural areas do not have toilets.

In recent times, there have been several instances of women refusing to marry into families who don’t have toilets in their homes, which officials attribute to growing public awareness about the health hazards of open defecation.

Dumka police, quoting Khushbu’s family-members, said that she was pressurising her parents for a toilet in her home as she was fed up and ashamed of defecating in open fields.

“Girl’s parents told her that they couldn’t afford a toilet as they were saving money for her marriage,” said investigating officer Manoj Mishra.

Her father Shripati Yadav is a driver.

“For us marriage was more important. She was demanding a toilet and on Friday we had a heated argument. She was stubborn and ended her life,” said a tearful Sanju Devi, Khushbu’s mother.

Police said that the girl ended her life when her parents were not at home.

“It is a tragic incident as girl’s parents were unaware of the importance of toilets,” said Dumka SP Bipul Shukla.

A government official said that under a government scheme, individuals are provided Rs 4,600 for household toilet construction.

“The parents seemed uninformed,” said a senior sanitation officer requesting anonymity.

A study by the Unicef earlier had identified poor sanitation as a major cause for diseases and deaths among children in the state and also showed how open defecation had a strong correlation with malnutrition (55%) and stunting (47%) among children of the state.
Riaz Haq said…
It's no joke. WaterAid says #India has 60.4% people without access to toilet. 36% in #Pakistan #opendefecation https://shar.es/1c08Z4

Noting that the resulting health crisis is a serious matter, the report said that more than 140,000 children younger than five years die each year in India due to diarrhea.
“Nearly 40 per cent of India’s children are stunted; this will affect both their life chances and the future prosperity of India. India also has high rates of maternal and newborn mortality linked to sepsis,” the report said.
The equipment necessary to prevent infection during and after child birth is simple and inexpensive, but requires clean water and soap along with clean surroundings, which are difficult to achieve in an environment contaminated by open defecation and without good hygiene practices such as handwashing with soap by clinic staff and midwives, it said.
Prime Minister Narendra Modi has given the sanitation issue a top political priority, and last year launched Swachh Bharat (Clean India) Mission.
Commenting on Swachh Bharat, which aims to ensure a toilet for every household by 2019 and to educate people about the long-term health and economic benefits of using a a proper sanitation system, the report said that “by simply building the toilets won’t be enough.”
“What will be absolutely crucial is getting local, state and national government to make this a priority, and creating the cultural shift that will ensure that once the toilets are built, they are used by everyone,” it added.

http://www.wateraid.org/what-we-do/our-approach/research-and-publications/view-publication?id=c8e9d0b5-3384-4483-beff-a8efef8f342a
Riaz Haq said…
From WaterAid 2015 Report "It's No Joke: State of the World's Toilets 2015":

India, the world’s second most populous nation, has a well-known problem with sanitation. Cities growing at an incredible pace with unofficial, unserviced slums, combined with cultural preferences for open defecation in fields rather than enclosed spaces, mean India has the World’s Longest Queues for Toilets. If you stretched all 774 million people in India now waiting for household toilets, the queue would stretch from Earth to the moon – and beyond! That queue would take 5,892 years to work through,assuming each person needs about four minutes in the toilet. The resulting health crisis is a serious matter. More than 140,000 children younger than five years die each year in India from diarrhoea. Nearly 40% of India’s children are stunted; this will affect both their life chances and the future prosperity of India. India also has high rates of maternal and newborn mortality linked to sepsis. The equipment necessary to prevent infection during and after childbirth is simple and inexpensive, but requiresclean water and soap, and clean surroundings, which are difficult to achieve in an environment contaminated by open defecation, and without good hygiene practices such as handwashing with soap by clinic staff and midwives. Work is underway in India to end the crisis. Prime Minister Narendra Modi has given the issue high political priority, and in autumn 2014 announced the Swachh Bharat (Clean India) Mission. Swachh Bharat aims to ensure every household has a toiletby 2019 and to educate people about the long-term health and economic benefits of using a toilet. This is an important and long-overdue initiative, and is bringing change to India’s communities. But simply building the toilets won’t be enough. What will be absolutely crucial is getting local, state and national government to make this a priority, and creating the cultural shift that will ensure that once the toilets are built they are used – by everyone.

http://www.wateraid.org/what-we-do/our-approach/research-and-publications/view-publication?id=c8e9d0b5-3384-4483-beff-a8efef8f342a
Riaz Haq said…
V.S. Naipaul understood the culture of open defecation when he said #Indians defecate everywhere http://go.shr.lc/24F1XDl via @riceinstitute

I recently picked up V.S. Naipaul’s book An Area of Darkness, a chronicle of his first trip to India published in 1964. Although some view the book as overly pessimistic and scathing, his portrayal of India’s culture of open defecation is uncannily accurate.
Shankaracharya Hill, overlooking the Dal Lake, is one of the beauty spots of Srinagar. It has to be climbed with care, for large areas of its lower slopes are used as latrines by Indian tourists. If you surprise a group of three women, companionably defecating, they will giggle: the shame is yours, for exposing yourself to such a scene.
In Madras the bus station near the High Court is one of the more popular latrines. The traveller arrives; to pass the time he raises his dhoti, defecates in the gutter. The bus arrives; he boards it; the woman sweeper cleans up after him.

In Goa, you might think of taking an early morning walk along the balustrade avenue that runs beside the Mandovi River. Six feet below, on the water’s edge, and as far as you can see, there is a line, like a wavering tidewrack, of squatters. For the people of Goa, as for those of Imperial Rome, defecating is a social activity; they squat close to one another; they chatter. When they are done they advance, trousers still down, backsides bare, into the water to wash themselves.

Indians defecate everywhere. They defecate, mostly, beside the railway tracks. But they also defecate on the beaches; they defecate on the hills; they defecate on the river banks; they defecate on the streets; they never look for cover.

A handsome young Muslim boy, a student at a laughable institute of education in an Uttar Pradesh weaving town, elegantly dressed in the style of Mr. Nehru, even down to the buttonhole, had another explanation. Indians were a poetic people, he said. He himself always sought the open because he was a poet, a lover of Nature, which was the matter of his Urdu verses; and nothing was as poetic as squatting on a river bank at dawn.
He eloquently describes in these vignettes what we have found 50 years later in the SQUAT and Switching Studies: that defecating in the open is the social norm. It is considered to be a part of the wholesome, rural life, in which one takes a walk outside in nature, socializes with friends, and avoids polluting oneself and one’s home.
Riaz Haq said…
The cultural politics of shit: class, gender and public space in India

Full text HTML
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Free access
DOI:10.1080/13688790.2015.1065714
Assa Doron & Ira Raja
pages 189-207

In this article we seek to interrogate the cultural, political and economic conditions that generate the crisis of sanitation in India, with its severe implications for the poor and the marginalized. The key question we ask is how to interpret and explain the spectre of ‘open defecation’ in India's countryside and its booming urban centres. The discussion is divided into three parts. Part one examines the cultural interpretation of ‘shitting’ as symbolic action underpinned by ideas of purity, pollution and ‘the body politic’. Part two takes the political economic approach to gain further insights into contemporary discourse, performance and cultural politics surrounding toilets and open defecation in India. Part three examines civil society activities, state campaigns and media accounts of open defecation to explore the disruptive potency of everyday toilet activities, and how these interplay with issues of class, caste, and gender. Drawing on interviews and a review of ethnographic work, we seek to interrogate the idiom of modern sanitation, with its emphasis on cleanliness, progress and dreams of technology, as a constitutive idea and an explanatory force in Indian modernity.

http://www.tandfonline.com/doi/full/10.1080/13688790.2015.1065714
Riaz Haq said…
How bad are most of #India's medical schools? Very, according to new reports. #highereducation #health #MEDICINE

https://www.washingtonpost.com/news/worldviews/wp/2016/04/21/how-bad-are-most-of-indias-medical-schools-very-according-to-new-reports/

In a country with the world's heaviest health burden, and highest rates of death from treatable diseases like diarrhea, tuberculosis and pneumonia, corruption at medical schools is an extremely pressing issue. The Indian Medical Association estimates that nearly half of those practicing medicine in the country do not have any formal training, but that many of those who claim to be qualified may actually not be.


a couple of recent studies and reports have cast serious doubts on the quality and ethics of the country's vast medical schooling system. The most recent revealed that more than half of those 579 didn't produce a single peer-reviewed research paper in over a decade (2005-2014), and that almost half of all papers were attributed to just 25 of those institutions.


The 2011 court case against a man, Balwant Arora, was one of the earlier indications of the massive levels of fraud. Arora brazenly admitted to issuing more than 50,000 fake medical degrees at around $100 apiece from his home, saying that each of the recipients had "some medical experience" and that he was doing it in service to a country that desperately needs more doctors. He had served four months in jail in 2010 for similar offences.

Private medical colleges have proliferated rapidly in India. When in 1980 there were around 100 public colleges and 11 private, the latter now outnumber the former by 215 to 183. Most are run by businessmen with no medical experience. Last January, the British Medical Journal found that many private medical colleges charged "capitation" fees, which are essentially compulsory donations required for admission. Jeetha D'Silva, who authored that report, wrote, "Except for a few who get into premier institutions of their choice purely on merit, many students face Hobson's choice — either pay capitation to secure admission at a college or give up on the dream of a medical degree."

The best public medical colleges have acceptance rates that are minuscule, even compared to Ivy League universities. Those colleges also tend to be the ones that produce the most research papers, as well as handle the most patients, which would seem to eliminate the possible excuse that overwhelming patient burdens prevent private colleges from producing valuable research.

The most productive medical college in India is also its largest public health institution, the All India Institute of Medical Sciences, or AIIMS. In the 10-year period that Samiran Nundy and his colleagues examined, AIIMS published 11,300 research papers. For context, that is about a quarter of what Massachusetts General Hospital produced in the same time frame.
Riaz Haq said…
Lack of toilets contributing to rise of #rape in #India – University of Michigan Study. , #opendefecation http://www.rt.com/news/370425-india-toilets-women-rape/#.WFTPBWX7tQ4.twitter …

Women in India who don’t have adequate access to sanitation facilities and are forced to openly defecate are more likely to experience sexual violence, according to a new study.
Approva Jadhav, a researcher from the University of Michigan, said that “open defecation places women at uniquely higher risk of type of sexual violence: non-partner” in the co-authored report.

In their findings, researchers said it was twice as likely for women without access to “household toilets” to face sexual violence than women who do have such access, suggesting that improvement of infrastructure and access to toilets would provide a safer environment for women.

“Women who use open defecation sites such as open fields or the side of a railway track are twice as likely to get raped when compared with women using a home toilet,” the study stated.

“Our findings provide further rationale for NGO’s and the Indian government to expand sanitation programs, and raise new questions about the potentially protective role of sanitation facilities in other contexts beyond India,” the research found.

Almost half of India’s population do not have access to basic sanitation and have to defecate in public and women appear to be affected the most.

“This is an urgent need that cannot be ignored anymore,” Ms Jadhav, lead author of the report, told NDTV. “We need more than anecdotes to bring a policy change.”


By analyzing data from the Indian National Family Health Survey along with an overall representative sample of 75,000 women who answered questions on accessibility to toilets in their homes and experiences of various types of violence, the researchers found that previous sanitation studies did not examine the synonymous link between the two.

The issue of India’s sanitation crisis being linked to sexual violence came to light in 2014 when two teenage girls were raped and hanged in Uttar Pradesh while they were making their way to fields to defecate.

In the slums of Delhi, where communities often have to share public toilets, girls under the age of 10 have been found to be at risk of “being raped while on their way to use a public toilet,” according to a BBC report, which also states that around 300 million women and girls in the country defecate in the open.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100257/

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