“I think I've been quite shocked by the importance of toilets.”
Little Mary Auma was just six months old when she was rushed for miles on a rickety bicycle to the local hospital in Kenya, only to die a few days later. She’d been suffering from diarrhoea and vomiting for a week.

That was 30 years ago and her mother, Magdaline, still pines for her every day.
“It took five years to get pregnant again because it was in my heart,” says Magdaline Amolo Aloo, through a translator. “It was too painful. She was very beautiful and she was my only girl.”
After her baby died, Magdaline became a community health worker, volunteering to educate her Kenyan village about sanitation and hygiene. “Her diarrhoea was something that could have been prevented,” she says. “I didn’t want other children to die.”
Yet even now, a child dies from diarrhoea every two minutes. A big part of the problem is that 2.5 billion people don’t have access to a toilet, so they defecate in the open, which leads to food and water contamination. It might not be a palatable topic, but it’s an issue that can’t be ignored when so many lives are being lost. And women and children are affected most.
The solution is a rudimentary latrine in a mud structure, with a jerry can rigged up for hand-washing and ash as a cheap soap substitute. UNICEF, with the support of Domestos and the Unilever Foundation, runs community-led sanitation programs all over the world, explaining the link between open defecation and disease- causing germs, and encouraging families to build their own latrines.

Tippy taps for hygienic water
'Tippy taps' are a simple but effective way to maintain hygiene without running water.  A foot lever keeps the process hands-free and avoids the transmission of bacteria. © UNICEF
In the western Kenyan county of Siaya, the program has been running for three years and the goal is for every village in the county to be ODF (open defecation free) by the end of this year.
Today, in the village of Nduru, the community is celebrating their new ODF status.
In the stifling afternoon heat, the villagers congregate under a jacaranda tree, schoolgirls rap and health workers sing about personal hygiene, gyrating and ululating.”
Some of the women are in their nest chiffon and sequins, while others wear T-shirts that say, “My Village is Open Defecation Free”.

To an outsider, the event may seem absurd, but latrines have transformed the villagers’ lives, especially the women’s.

Grandmother Alice Ndolo takes us to her property, where 12 family members live in three mud huts. Life was a struggle, she says, before she learnt about sanitation and set an example for her village, building a latrine four years ago.

“We just used to survive,” says Alice, 48. “We had a lot of diarrhoea and there were a lot of flies. We didn’t understand the relationship between the flies, our food and our health.”

Alice Ndolo stands by her latrine in Nduru Village
Alice Ndolo stands by her laterine in Nduru Village, which has been certified as Open Defecation Free since January 2015. © UNICEF

Diarrhoea regularly
 spread through the 
school and children
 would miss more than
 a week of classes with
 each infection.
 Meanwhile, mothers 
would have the worry of nursing them.

Without latrines, menstruation was also an issue. Girls would stay away from school every month, and after giving birth, it was arduous for women to deal with the bleeding. “After delivery, women used so much energy digging holes to bury the rags they would have a lot of pain,” says Alice’s daughter-in-law, Millicent Achieng Onyango. “Now we throw the rags away and continue with life.”

For women, who have 
to walk into secluded 
areas to relieve themselves,
 often under the cover of
 darkness, danger can lurk
in the form of snakes or lions, as well as predatory men. (Last year, in India, for example, two teenage girls were allegedly gang-raped and hanged from a tree after they walked into a field at night because they didn’t have a toilet at home.)

“Children used to die early. Now they can live and be happy.”
It’s no surprise that it’s the women pushing for change, but it’s the men – the traditional heads of the households – who have to be convinced.

In Luala Kaor village, mother of four Caroline Auma does not yet have a latrine. There is a striking difference – in pride and cleanliness – between Nduru and this non- ODF village. Outside Caroline’s mud hut, the yard is littered with plastic bags, old clothes and broken plates. Last month, her 14-month- old baby had diarrhoea for three weeks and almost died. “Women know that the latrine is important,” says Caroline, 28, who walks for two hours every day to fetch water, “but the husband has to decide.”

It was only recently that her husband came around. He was struck with diarrhoea himself – and finally decided to start construction.

Good sanitation keeps kids health for school
Sickness caused by unsanitary toilets means 443 million school days are missed every year around the world, so good sanitation doesn't just keep children healthy - it keeps them learning. © UNICEF

Here in Siaya – Barack Obama’s ancestral homeland – the President of the United States looms large. Our hotel has the Barack Obama Ballroom (no bigger than a dining room, with a collapsed ceiling), we drive by the “Official Barack Obama Bus Stop” and there has been a rash of baby boys named after him. The President’s 94-year-old step-grandmother, “Mama Sarah” Obama, is a local celebrity.

For the children, he is a potent symbol of possibility – a reminder that they can emerge from poverty, perhaps even lead the Free World – but first they need an education. That’s difficult enough with scant resources, but add the risk of disease and the dream must often feel beyond reach.

In Siaya, more children die of preventable illnesses such as diarrhoea than in any other region of Kenya, but change is on the way.

As her father-in-law shows off the family latrine, 21-year-old Mildred Achieng ponders a brighter future for her toddler. “Children can grow and complete their schooling,” she says. “They used to die early, but now they can live and be happy.”

This article was originally published in Australian Women's Weekly. World Toilet Day is on November 19.

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