Why do 25 million Pakistanis defecate openly?

During moments of reflection it sometimes occurs to me that, as a nation, we have been conditioned to only react to tragedies on a large scale. In the greater scheme of things, this ability to suppress emotional reactions to the trauma that surrounds us serves as a defence mechanism of sorts; one that allows us to go about each day without being overwhelmed by paralysing depression.

With this filter in place, we are able to circumvent the accompanying responsibility, writing off what we deem minor and letting it drown under a sea of other (more) pressing issues. Failing to comprehend the enormity of the basic, we allow it to escalate in scale and impact. Whether it is education, health or everyday dishonesty the pattern repeats itself over and over again like an algorithm programmed into our collective consciousness.

Let’s take two “minor” diseases, for example: many of us are blissfully unaware that every single day children in Pakistan die due to pneumonia and diarrhoea. I refer to them as minor because for most of us these two diseases barely even fall under the radar as dangerous, let alone life-threatening.

Yet, diarrhoea takes the lives of 53,300 children in Pakistan every year. That amounts to 110 children every single day. I was shocked to discover that diarrhoea actually kills more children than AIDS, malaria and measles combined. What is sobering to know is the fact that simple and inexpensive interventions can help prevent and reduce the incidence of diarrhoea, saving lives of children and protecting them from malnutrition.

The question that remains is: what makes diarrhoea such a recurring and pervasive disease in countries like Pakistan? The answer is shocking in its simplicity: lack of hygiene. Twenty five million Pakistanis defecate openly. It is an act instilled as a tradition in rural areas and practiced for generations. The concept of treating water before drinking and washing hands with soap is novel for a large percentage of the population in rural areas and urban informal settlements (katchi abadis). A large number of diarrhoea-associated deaths can be attributed to unsafe water, inadequate sanitation, and insufficient hygiene.

Strides made over the last 20 years have shown that diarrhoea prevention focused on safe water and improved hygiene and sanitation is not only possible, but cost effective: every $1 invested yields an average return of $25.50. I don’t think it would be too far off the mark to assume that this is reflected in the time and money saved on hospital visits, the cost of medicines, the opportunity cost of a day’s work for a daily wage worker and the economic cost associated with the loss of life.

I recently came across the project Sehatmand Gharanay, Khushaal Pakistan (SGKP) – globally known as ‘Save a Child a Minute’ – which aims to sustainably reduce the incidence of diarrhoea and prevent child deaths due to diarrheal diseases. By enacting a behaviour change model it focuses on improving hygiene practices while simultaneously empowering women to become agents of social transformation and lead change within their families and communities. To test the behaviour change model, SGKP has been running a pilot project in Dhori, Sargodha.

The pilot project has put into action three main pillars: educating village residents on the causes of diarrhoea and how to prevent it; providing low-cost health and hygiene products at highly subsidised rates; empowering women through an inclusive business model. Within the last six months that the project has been operating, it has already yielded favourable results. Through awareness activities and weekly community engagement the messages of hygiene and cleanliness are constantly reinforced. The number of women in the village who treat water before drinking has increased from 4% to 100% – such basic changes to everyday habits are acting as deterrents to the occurrence of diarrhoea. A public toilet for women has also been inaugurated and women hygienists have been trained to visit households every week to ensure that lessons of hygiene are being put into practice.

The way I see it, as this project grows in scale, it has the potential to create a strong impact and truly reduce cases of diarrheal deaths within the country. However, as individuals, we can also take steps to initiate change within our own spheres of influence. Passing on basic messages of hygiene to the less privileged individuals we come into contact with everyday can have a multiplying effect that can accelerate the rate of change and help us become part of something meaningful.

It’s important to remember – change doesn’t always require monumental gestures; sometimes it’s the little things that make all the difference.