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India is Drowning in its Own Excreta-Can Science and Engineering Come to the Rescue?

The views expressed are those of the author and are not necessarily those of Scientific American.

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Just a few weeks ago, I flew into India to join other new media specialists and journalists with the International Reporting Project to examine issues of child survival and health. (Before I continue, I simply must extend thanks to the Bill and Melinda Gates Foundation for providing a portion of the IRP funding to make this trip possible, the School of Integrative Biology at UIUC for supporting my participation in the project and GoPro Cameras for outfitting me with a Hero3 for documentation purposes.)

I have talked to many many people who have experienced India, I’ve read numerous books (fiction and non-fiction), and watched many documentaries, TV shows, and fictional movies about India, but knew that the experience of visiting would be something valuable. I was warned of the approximately “five people per square foot” population density in Mumbai, of the smell–a persistent sewer/trash odor, the pollution, the noise, the dogs, cattle, and goats, and the widespread extreme poverty. I discovered that the southern port city of India in Maharashtra State where we first landed, formerly known as Bombay, to be all that and even more. It was humid and warm during our visit, but actually in a relatively cool and dry streak, at least for India. The city, as I was exaggeratively informed by John Schidlovsky, founder and director of the IRP, “was built on mold” and with my allergy to mold so severe that I carry an epipen, I found myself taking more than the recommended dose of allergy meds just to breathe, each day grateful it wasn’t the rainy season. Thankfully, we traveled north to cooler, drier, and less moldy climes to a rural area outside Nagpur and later to New Delhi. I will discuss more of those destinations in future posts.

Throughout most of India, I found myself delighted at the fact that women still wear colorful sarees on a daily basis, not yet succumbing to western trends, and impressed that men and boys generally wear button-down shirts, slacks, and nice shoes everyday, no matter their income level or age (try convincing a young boy to do that in America day to day–no way!)

Sign reads Niramaya Health Foundation Regional Health Care Program by GlaxoSmithKline

Niramaya Health Foundation

If you have seen the movie “Slumdog Millionaire”, it begins in Mumbai, in one of the largest slums located near the airport and situated right at the largest dumping ground in India. This area was our first stop in order to visit the Niramaya project drop-in health center. We toured the slums and received an overview of healthcare and educational awareness work Niramaya does in the community.

A scene in a Mumbai slum. While many journalists took photos of people, I was uncomfortable invading their space

Many sights, sounds, and smells impacted, and even impressed me, but nothing I encountered really surprised me as I realized that poverty is poverty everywhere and people in India are just trying to live their lives as they go about their day, as anywhere else. Despite this acceptance of the state of living of slum dwellers, as someone who has an immense appreciation for modern plumbing, and armed with a good working knowledge about micro-organisms, I found myself uneasy at the thought of open defecation as practiced so widely in India.

An entire nation drowning in its own excreta is an unpleasant thought, but this is what is happening, at least according to Sunita Narain, Indian environmentalist and Director General of the Centre for Science and Environment, author of “Excreta Matters“, “India’s first and most comprehensive survey …on the state of its water and its management”, in a comment piece published on June 14 in Nature.

Open defecation is practiced by more than 600 million Indians, according to the World Health Organization. The WHO calls open defecation the riskiest sanitation practice of all due to the ease of disease spread. More often than not, water is contaminated by the same people who drink it. Open defecation is rampant in slums and rural areas because alternatives simply don’t exist as pit toilets and flush or pour toilets are found primarily in urban areas. In the slums and rural areas, there might be public toilet areas, however, due to long lines and privacy concerns, many residents still wait until nightfall to go –increasing the risk of related violence, especially against women and girls. Open defecation and ill-maintained sewage and septic systems leak pathogen-laden contaminates into surrounding rivers and lakes, leading to disease outbreaks of waterborne pathogens and contributing to early mortality and is a major contributor to malnutrition due to chronic diarrhea and possibly improper absorption of nutrients due to an imbalance of intestinal microflora from consuming pathogen-laden water and food in a condition/syndrome called “environmental enteropathy“. Infants and children under five years old are particularly susceptible to diarrheal diseases.

Al Jazeera reported on India’s “Sanitation Emergency” last summer. This video highlights the pertinent numbers and issues surrounding this crisis and includes the stunning statistic that more Indians have access to mobile phones than to toilets.

3 puppies resting in the shade cast by 50 gallon water drums

Three puppies resting in the shade cast by 50 gallon water drums, oblivious to the overwhelming odor of the chlorine tablets used for disinfection. These drums are filled with clean water shipped in by tanker trucks since no running water is available in this Mumbai slum

Before I left for India, I researched the issues that plague India’s children. Diarrhea and malnutrition are the largest killers of children under the age of five worldwide and is particularly pronounced in certain areas of India. Around 1,000 children below the age of five die every day in India from diarrhea, hepatitis-causing pathogens, and other sanitation-related diseases, according to the report of United Nations Children’s Fund. Microbial sources of these diseases can be protozoan (amoebosis), parasitic (schistosomiasis) viral (hepatits A) or bacterial (typhoid, dysentery, cholera).

In my quest to learn more about the role of sanitation in disease control, I contacted Scott Huler, author of “On the Grid: A Plot of Land, an Average Neighborhood, and the Systems that Make our World Work” , a book about modern necessities such as clean water, toilets and sewer systems we take for granted through most of the western world. He reminded me of an interesting bit of information, quoted here from a recent blog post of his:

… in 2007 the British Medical Journal asked its readers to name the most important medical milestone since 1840, they chose modern sanitation — which defeated things like, say, antibiotics or anesthesia or vaccines. And yet 2.5 billion people still don’t have it.

This is pretty incredible. Our knowledge of how drinking water must remain separate from wastewater has improved our health by leaps and bounds as a species/society. Understanding that waterborne micro-organisms cause disease and that hygienic measures can prevent illness is undoubtedly critical. In addition to that important BMJ survey, Scott pointed me to a book about toilets and sanitation worldwide by Rose George called “The Big Necessity: The Unmentionable World of Human Waste“.

Slate published excerpts back in 2008 which you can reference for a preview. Relevant to the topic of this article, I recommend this particular excerpt, Latrine Rights in India.

If you prefer your information in video form, Rose George gave a succinct and enlightening talk about the world of “crap” for TED in February and it was released last week. She highlights the issues facing girls and women in particular in India, fearing for their safety in public latrines and at schools.

So then, what is to be done, from a science and engineering perspective? Sunita Narain explains from her article in Nature:

The challenge for science is to look beyond the modern engineering mindset. We know that current technologies, which use large amounts of clean water to transport small amounts of excreta through expensive pipes to costly treatment plants, are unworkable and unaffordable in much of the world. Yet toilets and sewage disposal are among the least researched technologies.

New technologies and new thinking are urgently needed for use across diverse ecosystems. Open drains might become planted waterways, with the vegetation cleansing the water. Or microbes might be used to decompose and de-pathogenize effluent. Sewage must be treated as a resource — turned into water for drinking, irrigation or industry.

I’ll add to this broad thought that the agencies that are educating the people of India (most importantly the women) must continue to spread the word on how important good hygiene is to preventing deadly and debilitating diseases. I saw many examples of this while there through NGOs, physicians and other advocacy groups. So many people lack the understanding about the spread of disease and how simple it is to create a healthier community and nation.

images from India are Joanne’s

Joanne Manaster About the Author: Joanne Manaster is a university level cell and molecular biology lecturer with an insatiable passion for science outreach to all ages. Enjoy her quirky videos at, on twitter @sciencegoddess and on her Facebook page at JoanneLovesScience Follow on Twitter @sciencegoddess.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. dadster 6:25 am 04/25/2013

    Everything said here is absolutely correct. No dispute on that point. But ,India is a vast country compared to any of the European countries .India has wide and varied culture and an ancient river- based agricultural civilisation more than 5000 years old . The short period of about 200 years (1750 to 1950) of European influence with regard to trade and commerce on Indian civilisation and life- style made life in India city-centric converting it into a road- based one tom river- based and commercial from agriculture. The eruption of Slums were the by product of instant city- building to catch up with the fast- moving times. While life in cities have caught up , still, cities are a small fraction of India . Things are not that bad in the villages of India, as it is in the slums in cities.
    There is plenty of space and land and, people have enough free space outside in the form of fields , farms and forests near the still running rivers of India. Villages are swathed in blazing sun and bio- degradation of night soil takes only hours . Solar energy and running rivers and streams keep things hygienic too unlike in crowded cities. Villagers generally enjoy healthier and longer life- times too. So, the overhaul picture is not as bleak as it’s is made to look from a rather skewed perspective after being in the cities of India. Every specialist arriving in India wearing their own specialised professional spectacles focussed on specific issues will find a lot of grist to grind in their own mill; the vast diversity of India provides it . But that doesn’t mean everything is ticketty- boo . Professionals want results and remuneration for everything they do. Indians in villages are not professionals . Professionals look more for “efficiency” than for “understanding”. India is too vast a country with dynamic multidimensional cross currents of ancient civilisations still alive and operating,for lending itself to just professionalism or machine-like uniformity and efficiency . To appreciate India one has to get into the shoes of India . But , if one remains in one’s own western shoes and measures Indian conditions with her/ his own imported measuring rods and specifications, one is apt to find things wanting,substandard and deficient. Yet this is a good sales- pitch to sell your wares to India. Good try !

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  2. 2. SachiNewDelhi 6:18 pm 04/25/2013

    That 600 million figure (or half of India’s total population) may be a bit of a stretch. I had seen the TED talk too and the journalist was generalizing a bit too much.

    But probably that’s unavoidable.

    And yet, one should not look at life in New York City (both the multi-million dollar penthouse aspect of it and the Bronx aspect of it, and generalize about America.

    Of course, once you have some knowledge about the scale of problems in India, the financial crises affecting various European nations such as Greece or Spain appear tiny indeed.

    I don’t know what it says about humanity that there is simultaneously so much wealth and so much poverty around the world.

    Will it take another CENTURY to remove the wretched poverty that exists in India?

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  3. 3. Venze Chern 11:25 pm 04/27/2013

    The title of the article is eye-catching but its content over-exaggerating. The situation in populous India is too complex and multifarious to be aptly discussed in any short presentation.
    Sanitation remains a big issue in the sub-continent. The fast increase in population (especially among the poor) has virtually nullified whatever less-than-tangible effort made by the government along the direction. Still a long way to go. (vzc1943, btt1943)

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  4. 4. templeos 11:47 pm 04/28/2013

    God says…
    because they counted him as a prophet.

    14:6 But when Herod’s birthday was kept, the daughter of Herodias
    danced before them, and pleased Herod.

    14:7 Whereupon he promised with an oath to give her whatsoever she
    would ask.

    14:8 And she, being before instructed of her mother, said, Give me
    here John Baptist’s head in a charger.

    14:9 And the king was sorry: nevertheless for the oath’s sake, and
    them which sat with him at meat, he commanded it to be given her.

    14:10 And he sent, and beheaded John in the prison.

    14:11 And his head was brought in a charger, and given to the damsel:
    and she brought it to her mother.

    Link to this
  5. 5. templeos 11:49 pm 04/28/2013

    There was a famine.

    Link to this
  6. 6. templeos 11:50 pm 04/28/2013

    Faces of death monkey.

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  7. 7. rajaspidey 8:12 am 04/29/2013

    I deny this. You have seen only Mumbai. Come to southern parts like chennai it ll be good. but slum around the city is unavoidable.

    Its due to the westernization India became like this. we had better civilization than all you western ppl.

    After british rule everything changed. they took all riches from our country & left it only when it became poor.(silly to say but thats the truth)

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  8. 8. rajaspidey 8:15 am 04/29/2013

    Those who fully understands India loves India, Ex: Beatles, Kula Shaker…..

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  9. 9. Mukul 11:29 am 04/29/2013

    Standard Indian Defence –
    5000 year old culture! As if the rest of the world started yesterday.
    Western Civilization is to be blamed…of course they are, but we can’t live without my cellphones, cars, television and more!
    But who cares about (western) sanitation systems or their opinions? The blazing sun will do the work for you….in a mostly hot, humid tropics? Seriously?
    Running streams and rivers, in most cases just carry your ‘nightsoil’ to other ‘Indian’ villages, towns, cities!
    Instead of musing about the lost glory of yesterday, can the brilliant Indian scientists / engineers come to rescue of western civilization and develop a sanitation system, which saves at least 100 of those 1000 children which die everyday?

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  10. 10. sciencegoddess 11:32 am 05/1/2013

    I can understand that the title would create a visceral reaction, and if you read the article closely, with its links to sources for the numbers I quote from the WHO and UNICEF, you will notice that that phrase comes from Sunita Narain, Indian environmentalist and Director General of the Centre for Science and Environment. Her contact information is easily found and perhaps you can take her wording up with her. Phone:+ 91-11-29955778 E-mail:

    We primarily visited slums and settlements in our visit, and of course I realize that India is much more than the small snapshot I presented here.

    I was also in Nagpur and New Delhi. I would love to see the southern and eastern parts of India. My understanding is that especially in Kerala, where Christian missionaries had come in and brought education and health care, the level of hygiene and sanitation is higher and infant and child mortality is lower. The level of education is higher and women are more present to the idea of the scientific reason behind good hygiene and health rather than superstition or being mired in patriarchal customs that oppress women and impede their empowerment.

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  11. 11. rock johny 4:33 pm 05/1/2013

    In a country filled with people who think it’s just dandy to drink urine from free roaming cows in the street, they might have a challenge on their hands.

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  12. 12. rambansal 5:56 pm 05/1/2013

    A bird’s eye view is not a view at all. To be able write on a problem, you need to live with the problem and experience it. Open defecation in rural areas in India is more desirable than having latrines in homes and polluting the streets or the ground water and, most importantly, causing quarrels in the society. I have lived the problem closely -

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  13. 13. wmroche 6:26 pm 05/1/2013

    How is how Dubai is handling this problem??
    The modern Arab world!! You have seen those architectural wonders of Dubai .

    However, none are hooked up to a sewer system!

    The two minute video below passes a line of 100′s of poop trucks and never gets to the end .

    What were these people thinking? (language is a little coarse, no,,,, it is a lot coarse)

    An unbelievable amount of sewage is generated by the new high-rises and there is no place to dispose of it.

    Look at the number of tank trucks that are waiting to dump their load. They wait for days to dump their load.

    You would have thought that by building all those huge skyscrapers they would have enough sense to put in a sufficient sewage system to haul away all that crap.

    You would imagine that those building that look amazingly beautiful were built on a well-planned system of utilities. But, that’s NOT TRUE!!

    Makes you wonder where they are dumping it all.

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  14. 14. American Muse 1:36 am 05/3/2013

    India remains poor and miserable because basic human rights has no meaning in that country. Hinduism publicly incorporates and endorses this bigoted view of people by immutably classifying humans into castes based on their birth circumstances.

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  15. 15. stan e m 12:45 pm 05/3/2013

    Sewers are wasteful and kill millions,composting is safe and cost efficient.Compost can be burned if necessary.

    Link to this

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