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I’ve recently been working on the cholera outbreak in Yemen, and I think we’re talking about the biggest cholera outbreak recorded ever, we’re well up around one million cases now, which is just really hard to fathom.

Peter

Poo is not taboo

Special guests:

Peter McArdle, Australian aid worker

Host:

Marie Bout, Australian Red Cross

Have you ever considered what it would be like to live without a toilet? How about that endless stream of clear clean running water that comes out of your tap? Well when you really consider it, something like doing a poo… could be really quite messy without the right… infrastructure.​

Marie

Hi, my name’s Marie Bout and you’re listening to How Aid Works.

Today I caught up with Peter McArdle who’s been described as a pro toilet maker. He’s a WASH expert with the International Committee of the Red Cross, and works all over the planet.

Peter, tell me how you started on this mission to make sure poo is not taboo?

Peter McArdle

I started engineering because I like building stuff, as many 18 year old engineers do, aspiring engineers. When I was at uni I was a member of the Engineers Without Borders chapter in Newcastle Uni. I got involved with them for a little while. I actually did a placement with them in far North Queensland as my first sort of foray in pro bono engineering. And from that, I – I was doing that at the same time as working full-time, I worked for Hunter Water in Newcastle, the public water board, and building up some experience through that job. And then the two sort of combined my own professional skills and my interest in the more humanitarian side of things combined quite nicely, and I just applied for my job at ARC, Australian Red Cross, and here we are.

Marie

So in press you’ve been described as a pro-toilet maker.

Peter McArdle

Pro-toilet maker, for sure. For sure.

Marie

What does that exactly mean? Obviously you don’t go making the cistern. Like, what does it entail?

Peter McArdle

Well it can mean that.

Marie

Really?

Peter McArdle

Yeah, sometimes. So in my first job, which was in Vanuatu, that was a big latrines programme on one of the remote islands in Vanuatu, Ambrym, and that did actually physically involve making toilets. That was – it was a very remote community and of course when you’re out in the middle of nowhere then it’s really important to make sure your materials are – or the things that you use in your projects are sustainable, and so we were using lots of local materials, and so there are some best practice sort of techniques for doing that, and so I was actually working with the community to actually build their latrines. And so it can mean that, these days there’s lots of that. But yeah, it can look like all sorts of things.

Marie

Why is it so important to have enough toilets? Like, let’s break it down. I mean obviously don’t think about this because most of us have toilets readily accessible, but is it really a problem in some communities?

Peter McArdle

For sure. So in Australia, yeah you’re right, we don’t tend to think about that because everyone has a toilet it’s something that’s so readily accessible. But that’s not the case for everybody in the world, I think – I should brush up on the figures but I think it’s – it’s whatever, a billion people in the world who don’t have access to such facilities. And of course if you don’t have access to improved sanitation, and we’re not necessarily talking about a flush toilet like we know, it can be something a bit simpler than that, but what we are talking about is something that’s clean, something that’s safe to use and can dispose of waste safety. And yeah, if you don’t have access to that sort of thing then it becomes a real health issue more than anything. So there’s a big overlap between water and sanitation and health because they’re so closely intertwined.

Marie

So what are people doing if they don’t have access to sanitation and toilets and hygiene?

Peter McArdle

In some communities, that results in what we call open defecation which is just doing your business in the open, in a field by a river, whatever it might be, and of course that can be a catalyst for the spread of waterborne diseases which is like cholera or like – water can carry bacteria like e-coli and that can cause diarrhoeal problems of course in the community if the water is not treated after that. So getting to that issue at the root is essential for community health.

Marie

Water is obviously a really, really important thing. People always thing about drinking water but surely it means more than that. What’s safe water?

Peter McArdle

Well that – I mean that is the main thing I think to think about it as safe drinking water, but it’s also – you use water for other things other than drinking of course, so things like cooking, for example, if you can imagine you’re preparing a salad and you need to wash it, of course you need drinking water for that. It’s the same issue really as drinking it, if you’re preparing food with contaminated water then that’s going to cause people to get sick as well. So that’s also an issue. You need water to be able to wash your hands, not always but typically, unless of course, you know, if you’re using a soap to do that then of course you need water as well. And then, as you say, drinking is the big one. An issue of water is not always about cleanliness, per se, sometimes it’s about quantity, so having enough water to drink. So even if it’s clean, you know, if you don’t have enough that’s also a problem. Occasionally we might even team up with our other colleagues who work in other areas like health, of course if you’re running a hospital need clean water in a hospital for whatever that might entail, operations and treatments. We might team up with our colleagues who are working on agricultural projects so, of course, you need water to grow your crops. That’s fairly large scale stuff but it’s also something we look at now and then. So yeah, it can look like many different things, it really depends on the context of where you’re working and exactly what’s going on and the challenges are.

Marie

So on the very extreme end of the scale, if a community is like completely drought-stricken, there’s no water to be had, what does an organisation like Red Cross Is it simply bringing in water?

Peter McArdle

No, not necessarily. I mean, same sort of thing, it really depends on the details of the context, you know, is there water available nearby, is it – what’s the problem, why can we not access the water, is there just none really available, is it too deep, is it in the ground, has it not rained, what’s the issue there. So it really depends on exactly what’s going on.

Marie

So would you then maybe build some wells or look at a piping system? Or what kind of practical things do you do?

Peter McArdle

Yeah, so I’ve done a few things over the years. So there’s a couple of times Pacific where – so in Vanuatu we were looking at some shallow wells, putting hand pumps in, something quite simple, a really simple technology to access some of the groundwater. I did a project in the Marshall Islands which is way in the middle of the Pacific’s but as far away from main continental mass that you can get, and actually what their problem was, was that they had a drought even though you’re in the middle of the ocean. And so in that context we were actually taking the salt out of seawater.

Desal. On a very minor scale and only in an emergency, because that sort of thing is not super sustainable in the long term, but to address immediate needs that’s something that we were doing. Then all sorts of different contexts. If you start looking at places – I’ve worked in the Middle East in Yemen, for example, where the water table is very deep, we’re talking about 200 metres below the ground, and so in that context it’s helping people to access that water through larger pumping systems. But also a really important thing that we were doing there is working with people in water efficiency, so recognising that, yeah, we don’t have much water to go around so perhaps we can look at some ways of reducing water consumption, and that can play out in many different ways, in agricultural techniques, in household usage. It can look like many things.

Marie

I mean when you talk about things like household usage or agricultural techniques, there’s a big educational component in WASH.

Peter McArdle

For sure. For sure. Particularly when we talk about the hygiene, the H in WASH, we say there is never any hygiene – we never run a hygiene project without an education element. So, you know, we’re not going to just distribute materials, we really have to get out into the community and address the education element of that. You know, in some contexts it might be – some learnings are in hand washing, in other contexts that’s common knowledge and so it’s more looking at, okay, how do we adapt to new circumstances and that sort of thing. But there’s always an education element to it, yeah.

Marie

Do you find – is it quite difficult to change people’s minds? Like, is the educational component generally easy? I’m trying to think what it would be like for a community that’s never had toilets and soap and...

Peter McArdle

Yeah, it can be tricky, for sure. When we were working on Ebola in Sierra Leone there was a common cultural practice there around washing of the diseased and of course in a situation like that when the virus is waterborne, and so that’s a context where it could spread very easy. And that’s a deeply held cultural tradition and you need to respect that but also teach people what the risks are, and that sort of thing can be very challenging, for sure.

Marie

So how did you find people received that? I mean it’s when people were grieving massively to sort of suggest this tradition’s not very good for them. I mean you wouldn’t say, you know, it’s unsafe.

Was that really challenging?

Peter McArdle

It’s a real challenge. You have to – you have to – it takes a lot of work and it’s not just us engineers doing that sort of thing, it’s – we had four teams of people out there and the Sierra Leone and Red Cross teams out there in the community really trying to raise awareness of what was going on.

Marie

Was that personally challenging for you? Like, working – because the Ebola crisis had massive media coverage and I think it was a bit nightmarish really, some of the stories, it was awful for the communities but also pretty scary to go there as a healthy person and kind of insert yourself into that. And challenging to see really sad things happening to families.

Peter McArdle

Yeah, no question about it. Yeah, really tough actually, but at the same time I think when you landed there and when you go to the treatment centres that we were running as Red Cross, you immediately see like the professionalism and the really quite great lengths that we were going to to protect people, and that gave you a lot of confidence. So, for example, I was there for, I think, six weeks or so and I didn’t touch anyone the whole time, it was a no-touch mission that we called it. And so that was one of the protocols, you couldn’t shake hands, you couldn’t tap someone on the back, you just couldn’t touch anyone. And that sort of really strict protocol gives you a lot of confidence in the safety procedures and then that lets you do your work.

Marie

It must be hard.

Peter McArdle

At the start you balk a little bit, yeah, you sort of go in for the handshake or, you know, those habitual things, but you get used to it.

Marie

Yeah. And when you came home did you just like hug someone as soon as you got off the plane?

Peter McArdle

For sure. It was really nice actually because, you know, of course back home people are worried about it as well, but thankfully I think the first thing I did when I got home, a housemate came out and gave me a big hug which was really nice.

Marie

I was going to say, I’m surprised your housemate wasn’t like, “Hang on a minute, have you been quarantined?”

Peter McArdle

Yeah exactly, exactly. So it’s good, she’d clearly done her reading.

Marie

Cool. Well that’s really interesting. Is there anything else you want to say about WASH and how it mitigates or helps a disease outbreak or, you know, how it helps. Do you want to talk about cholera?

Peter McArdle

Yeah, for sure. So I’ve recently been working on the cholera outbreak in Yemen which – it’s got a little bit of attention over here but I think relative to the scale of it, not much, because it really is just off the charts, it’s – I think we’re talking about the biggest cholera outbreak recorded ever and we’re well up around one million cases now which is just really hard to fathom, and that is a water and sanitation and hygiene issue really. Of course it’s a health issue at some point if people are being admitted into clinics and so on. But before that is really where the majority of the work is, I think...

Marie

Is that just because cholera is waterborne or...?

Peter McArdle

Yeah, basically, and also in terms of the hygiene element of that, that we’re not just talking about drinking water but we’re talking about ensuring hand washing, making sure people have access to the materials they need to be able to maintain good hygiene practices.

Marie

So it’s about when a disease outbreak starts, stopping it as quickly as possible by kind of stopping its spread. Is that the main...

Peter McArdle

Stopping the spread, yeah, for sure, that’s it, exactly. So that – in that context, a lot of – I mean cholera is not Ebola in the sense that it’s not nearly as fatal.

Marie

Easily preventable as well, yeah.

Peter McArdle

Yeah. So cholera, it’s waterborne but it doesn’t have the same fatality rates as something like – as Ebola. So what that means, therefore, so even though you might have a situation where – okay so I think of those million or so cases we’re talking in the thousands of deaths which is obviously still horrible, but relative to the cases it’s fairly low fatality rate. And what means, what that tells us is that the hygiene space, the talking about stopping the spread, is really where the bulk of the work is, making sure – again, making sure people have access to the materials they need to maintain. So it’s basic stuff, it’s soap, it’s chlorine, this sort of thing. Making sure that people can keep their water safe and free from re-contamination, making sure that people know how to do that, I mean people are very resourceful of their own accord, they don’t always need us to teach them things but, you know, they need to know where they can access things, or maybe if there’s something specific to an outbreak that they might not have seen before, making sure that people are informed.

Marie

Yep. So does soap really work? I mean it’s such a little, simple, cheap thing, I mean hotels give it out all the time.

Peter McArdle

Yeah, true.

Marie

Is it really that efficacious?

Peter McArdle

Yeah, it really is, it really is, yeah.

Marie

Really?

Peter McArdle

Yeah, no, definitely, soap is – soap is an essential thing for reducing the spread of disease, for sure, yeah. There’s some, you know, alternative things that you can use when soap is unavailable, but really it’s such a simple thing and so common and cheap too, it really is often a really powerful tool, something so simple, something so commonplace for us.

Marie

Are there, like, soap distribution schemes or like – I mean do a lot of communities not have access to soap?

Peter McArdle

Sometimes it’s the soap, sometimes it’s the water, sometimes it’s the convincing people that that is a worthwhile endeavour, I mean it’s not – for us I suppose it’s probably seen as a fairly commonplace item, but it’s not always and sometimes it – you know, any extra cost is an added expense. But then often the way you can show its value-add I suppose is actually, you know, the costs of being sick generally far outweighs the cost of a bar of soap.

Marie

Yep. And it’s smells so nice.

Peter McArdle

It smells nice.

Marie

I was reading how WASH impacts stuff like life expectancy. So I mean if you want to say anything on that, like I find it interesting, WASH has impacts on life expectancy, gender equality.

Peter McArdle

So as a health intervention, really you can look at it like that often in the same way that other health interventions, you know, increase life expectancy, so does access to clean water and sanitation. It’s something that affects the young and the elderly disproportionately because they are typically more vulnerable to infectious disease or to a diarrhoeal disease. You mentioned gender. Gender is a big element of our work in the sense that in many communities around the world there is a bit of a bias, a gender bias, in terms of who actually deals with water the most, and often it’s – often it’s women in many communities around the world who are – who might be the water fetchers, the cooks, looking after the kids. Often this is the case in many communities and therefore the heaviest water users, and so we need to make sure wherever we can that those people who are affected most by interventions with water also have a proportional say in the decision-making, and so the most vulnerable and the most affected in our work have a due voice.

Marie

That’s amazing. So where have you seen WASH have the most impact? Like have you got any great examples of where you’ve kind of – particularly if you’ve gone somewhere and you’ve worked on improving WASH or delivering WASH and gone back later and seen dramatic changes.

Peter McArdle

So one of the themes, we have some different these in WASH, we talk about WASH in emergencies, WASH in more development context, public health. But actually one of the ones I find most interesting is what we call urban WASH, so WASH in cities in highly populated areas. And it’s particularly interesting because it has its own set of challenges but it also has a huge potential for impact because when you have these highly dense populations, of course that holds some opportunity to reach lots of people as well. So these sorts of projects typically they tend to be larger in scale, so suddenly you’re talking about large city-scale infrastructure, water treatment plants, waste water treatment plants, this sort of thing, pumps and pipes. And, you know, so this is quite different to a rural setting where you might be putting a hand pump or something for a small community, suddenly you’re talking thousands, tens of thousands, of people. So I’ve worked in some contexts where we were working with the local water board to replace equipment in a city scale water pumping station. What that means is, essentially, that we’re trying to provide water for, I think I was 800,000 people, in that particularly context. And there’s similar ones, the list is long, of work we do like that. Certainly there’s lots of those sorts of contexts in conflict settings where we work often where the Red Cross is really in there working on this big infrastructure as well your sort of community level interventions.

Marie

Is it really different in a conflict setting or a post-conflict setting what you’d do?

Peter McArdle

I think one of the key differences when you start talking about conflict or post-conflict services is the interconnectedness of different services. So what I mean by that is that, and this is always the case in any setting but particularly or acutely in conflict, the – so – alright, so we’re working on water per se but of course that has a direct effect on the ability of the health services to function because we’re supplying them. Sometimes we’re also working, you know, in schools in urban settings like I said. The way that these services all interact with each other is more acute in a conflict setting. So, for example, if you have a water treatment plant that is damaged, it’s – there’s an urgency there in conflict to address that issue because that’s also having a direct effect on health services that might also be under an extreme amount of pressure. And so I think it’s that urgency, that acuteness that you see in conflict that makes it – that separates it a bit from, say, development settings where you – where you had more time really to do a slower, more – more – actually leave that end bit off.

Marie

Is there any kind of final thought you want to say? Anything about WASH? How you love toilets? How you love soap? Is there anything you want to say or like, you know, do you love your work or do you recommend people get into WASH? Do you think it’s something people need to learn more about? You know, anything at all.

Peter McArdle

Well there’s plenty more work to do so there’s always scope for getting involved if you’re interested. I think what I said about ‘my poo is not taboo’ catchphrase, you know, it sounds a bit tacky perhaps but it’s actually really important because there are some issues around WASH that are not super easy to talk about even in our own community. So just toileting practices is an obvious one, menstrual hygiene. Something that people are not always comfortable talking about but they’re really important issues and affect people’s everyday lives, their ability to go about their business safely and with dignity. And so it’s something I would always advocate for the breaking down of those sorts of taboos and trying to get conversations happening around these issues.

Marie

So your final thought is? Poo is not taboo?

Peter McArdle

Poo is definitely not taboo.

Marie

Awesome. Thank you.

So next time you go to sit on a toilet to take care of business, you can consider how wonderful it is to have a flushing toilet, clean water, and lots of soap… and how essential the things we take for granted really are for your overall health and survival.

That was Peter McArdle, an Australian WASH expert with the International Committee of the Red Cross, and you’re listening to How Aid Works, my name’s Marie Bout.

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