When shock and shame keep disease at bay

By making a map of his village, including the areas of open defecation, M. Binh gets his community to understand the link between sanitation and disease.

Vinh Thanh village is nestled in the Mekong Delta region of southern Vietnam, famous as a major rice growing area. On a sunny morning, residents have come together to attend a special performance. The atmosphere is relaxed and cheerful, and the village health workers organising the session are pleased to see such a large audience.

"Today we will invite you to see with your eyes where diseases like diarrhoea - which represents a huge problem for our community - come from and how to get rid of them," M. Binh, one of the village health workers, starts. "But first I’ll invite one of you to join and help me draw a map of our village."

Using bits of thread to mark the main road, blue lint for the river on each side of the village, and leaves to symbolise the paddy fields, the volunteer is progressively giving shape to a representation of the village on the ground. M. Binh is good-humoured and villagers soon join in with enthusiasm as he asks them to define other landmarks with bits of paper and sandstones: houses, the Buddhist temple, the school.

From ‘walk of shame’ to behaviour change

"Now, people have to eat every day and then they have to release it somehow. Where does this happen," M. Binh asks in a cheeky tone. Overwhelmed by embarrassment, spectators keep an uneasy smile on their face. But it doesn’t last long. Giggles soon erupt from the audience. "Come on! Each one of you take yellow powder and show me where this happens," M. Binh says. Volunteers now mark the various excreta sites around the village. They will later be asked to go and see real defecation spots all around the paddy fields, where they'll be told about the high risk of contamination to the food they eat and the water they drink from germs in human waste.

This 'walk of shame' is meant to help the community understand the harm that their defecation practices can have on their health and well-being, and ultimately trigger behaviour change. Calculating the health costs incurred is also part of the process.

Piloting a new approach

Through this session, residents of Vinh Thanh village are taking part in a new Community Approaches to Total Sanitation (CATS) project that has proved successful in many other countries. Currently only two out of five families in Vinh Thanh have toilets. Although Vietnam has made substantial achievements in water supply, progress in sanitation and hygiene is still lagging far behind, especially in rural areas, where 70% of the country's 86 million inhabitants still live. According to the 2009 National Census, about 60% of people living in rural areas don't have access to hygienic latrines.

CATS has led to improved sanitation conditions for hundreds of households in Vietnam. "The communities are showing great ownership of the CATS initiative and are very enthusiastic about the approach, which is not only improving their sanitation status but also enhancing their dignity," says Rajen Kumar Sharma, head of UNICEF Vietnam's Provincial Child-Friendly Programme, which supports the provision of integrated services for children in six provinces in Vietnam.

Mrs Vo Thi Mit of Vinh Binh village, which is just next to Vinh Thanh, had modern toilets built outside her home following a sensitisation session six months ago. "It's been an eye-opener for me," she says. "I would never consider going back to the fields. I feel disgusted by the old habits."

The CATS approach helps parents understand the value of proper sanitation. "The walk of shame we did in the village, looking at all the risks we take when we defecate in the fields, was a real shock for me," says M. Vo Van Ngan of Vinh Binh. "It made me understand all this was about making sure my children are growing up healthy." He spent 12 million dong (two month's salary) to build his own toilets. "I'm a farmer, I grow rice. My wife is a street food vendor. We don't make much money. Of course I realised it was expensive to build latrines, but we know it's worth it," says Ngan.

Through the CATS initiative, progress towards total sanitation in rural communities has been impressive. Since 2009, 33 villages across five provinces have been declared Open Defecation Free (ODF). The approach is being replicated in other communes by the Vietnamese government.

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