Excreta disposal in emergencies: Bag and Peepoo trials with internally displaced people in Port-au-Prince DEEPA PATEL, NICHOLAS BROOKS and ANDY BASTABLE After a series of earthquakes devastated Port-auPrince, Haiti, safe excreta disposal became an urgent priority After a series of earthquakes devastated Port-au-Prince, Haiti, on 12 January 2010, safe excreta disposal became an urgent priority. To mainstream innovative approaches to sanitation within the realities of urban humanitarian response, Oxfam GB undertook a trial from April to May 2010, of standard bag and Peepoo excreta disposal systems in two IDP settlements. Trial results demonstrate that with proper collection and removal, both bags and Peepoos are viable excreta disposal options in emergencies. A reduction WASSEENIN@mYINGTOILETSOPENDEFECATIONANDUSERREPORTSONDIARRHOEA in both settlements. For in-home use, the Peepoo was preferred over bags, 84 per cent to 55 per cent (F2 = 6.15, p=0.013) based on its ability to contain odour. Key programmatic recommendations include contingency planning for disaster-prone areas and further analysis of cost effectiveness and phase-out points for bag excreta disposal systems. Additionally, the Peepoo size should be adjusted to be more widely applicable in diverse emergency settings. Keywords:DEFECATIONINBAGSmYINGTOILETS(AITI0EEPOOSANITATION URBANHUMANITARIANRESPONSE A SERIES OF EARTHQUAKES STRUCK (AITI ON *ANUARY IN THE AREA AROUNDTHECAPITAL0ORTAU0RINCETHESTRONGESTOFTHESEREPORTEDAT ONTHE2ICHTERSCALE'OVERNMENTOF(AITI4HEEARTHQUAKE AFFECTED (AITIS MOST POPULOUS AREA KILLING APPROXIMATELY PEOPLE AS WELL AS DEVASTATING ITS ECONOMIC AND ADMINISTRATIVE CEN TRE 5. /#(! 4HE NUMBER OF INTERNALLY DISPLACED PEOPLE )$0IDENTIlEDISMILLIONINOVERSPONTANEOUSSETTLEMENTS THROUGHOUT THE AFFECTED AREA 5. /#(! *UNE RANGING FROM SUBSTANTIAL CAMPS OF UP TO PEOPLE TO HUNDREDS OF SMALL TO MEDIUMCAMPSWITHFEWERTHANRESIDENTS Deepa Patel is with WASH Research and Development, Oxfam Great Britain; and Nicholas Brooks and Andy Bastable ([email protected]) work for Oxfam Great Britain. © Practical Action Publishing, 2011, www.practicalactionpublishing.org doi: 10.3362/1756-3488.2011.006, ISSN: 0262-8104 (print) 1756-3488 (online) Waterlines Vol. 30 No. 1 January 2011 62 D. PATEL et al. Haiti pre-earthquake sanitation situation Improved sanitation facilities in urban areas of Haiti have been steadily declining from 1990 )MPROVEDSANITATIONFACILITIESINURBANAREASOF(AITIHAVEBEENSTEADILY DECLININGFROMWITHPERCENTIMPROVEDACCESSTOWITH PERCENTIMPROVEDACCESS7(/5.)#%&)NTHEABSENCEOF A REGULATORY AGENCY RESPONSIBLE FOR SANITATION INDIVIDUALS ARRANGED THEIROWNSANITATIONACCORDINGTOTHEIRECONOMICMEANS)&2# 4HEMOSTRECENTlGURESPRIORTOTHEEARTHQUAKESTATETHEREMAINING PERCENTOFURBANDWELLERSSHAREDTOILETSWHILEPERCENTHADACCESS TOUNIMPROVEDFACILITIESANDPERCENTDEFECATEDINTHEOPEN7(/ 5.)#%& 3ANITATION COVERAGE STATISTICS ARE NOT AVAILABLE DISAGGREGATED TO REmECTTHELOWERCOVERAGEAMONGSTPOORANDVULNERABLEPOPULATIONS LIVINGINDENSELYPOPULATEDORMARGINALAREASOF0ORTAU0RINCE.OR DOTHEYACCOUNTFORTHEANECDOTALEVIDENCEOFTHEWIDESPREADUSEOF PLASTICBAGSFORDEFECATION Post-earthquake sanitation situation The earthquake damaged the limited sanitation infrastructure that existed in Port-auPrince 4HE EARTHQUAKE DAMAGED THE LIMITED SANITATION INFRASTRUCTURE THAT EXISTEDIN0ORTAU0RINCEANDSURROUNDINGAREAS4HESCALEOFDEVAS TATION DEATH AND DISPLACEMENT AFTER THE EARTHQUAKE AND IMMINENT RAINYSEASONCREATEDCHALLENGINGCONTEXTSWHICHLIMITEDTHEABILITYOF HUMANITARIANRESPONSETOUTILIZEEXISTINGBESTPRACTICES Conventional emergency sanitation approaches 4HERE IS AN ASSORTMENT OF CONVENTIONAL SANITATION SYSTEMS RANGING FROMSEPTICTANKSTOBUCKETLATRINESANDEACHAPPROACHHASSTRENGTHS AND WEAKNESSES WITH NO lRM PANACEA TO BE RAPIDLY ADOPTED AND SCALEDUP!NYSANITATIONSOLUTIONUTILIZEDSHOULDBEEXAMINEDBASED ONAPPROPRIATENESSOFCOVERAGESPACELIMITATIONSMODULAR ITYMAINTENANCESOCIOCULTURALACCEPTANCEANDECONOMICS &ENNERETAL /XFAM 'REAT "RITAIN /XFAM '" RAPIDLY SCALEDUP ITS EXISTING COUNTRYPROGRAMMETODELIVERAMAJORWATERSANITATIONANDHYGIENE 7!3( RESPONSE 3ANITATION COMPONENTS INCLUDED PORTABLE TOILETS LATRINECONSTRUCTIONTRENCHLATRINESELEVATEDTANKLATRINESANDURINE DIVERSIONTOILETSLATRINEMAINTENANCEANDDESLUDGINGSUPPORTEDBY COMPREHENSIVEPUBLICHEALTHPROMOTION 4HEDIVERSITYOFACTIVITIESWASNECESSARYBECAUSEOFTHEMYRIADCHAL LENGES OF PROVIDING SANITATION FOR THE QUANTITY OF AFFECTED PEOPLE IN THE (AITIAN URBAN CONTEXT 4HESE CHALLENGES INCLUDED HIGHDENSITY CAMPSCOMPLEXLANDOWNERSHIPGROUNDCONDITIONSEGCONCRETEUN STABLESOILINSUFlCIENTPERMISSIONTOEXCAVATE)$0PERCEIVEDSECURITY January 2011 Waterlines Vol. 30 No. 1 EXCRETA DISPOSAL IN EMERGENCIES: HAITI 63 RISKSFREQUENCYANDAVAILABILITYOFDESLUDGINGANDABSENCEOFOFlCIAL PLANSFORCAMPFUTURES)NTHEFACEOFSUCHUNPRECEDENTEDNEEDFORIN NOVATIVESANITATIONSOLUTIONSCOUPLEDWITHTHEPREEARTHQUAKELEGACY OF MINIMAL ACCESS TO IMPROVED SANITATION CONSEQUENTIAL ESTABLISHED COPING MECHANISMS HABITS AND ATTITUDES REGARDING TOILET USE IN PAR TICULARNEEDEDTOBECONSIDEREDIFSANITATIONPROGRAMMESWERETOBE TECHNICALLYDELIVERABLEANDSOCIOCULTURALLYACCEPTABLEINTHETIMEFRAME NECESSARY !SURVEYCONDUCTEDINTHE0½TIONVILLE#LUB#AMPBY/XFAM'"IN &EBRUARYFOUNDTHATONLYPERCENTOFCAMPRESIDENTSSURVEYED USEDTHELATRINESPROVIDEDBY/XFAM'"WHILEPERCENTCONTINUED TOUSELATRINESINEARTHQUAKEDAMAGEDSTRUCTURES&URTHERMOREPER CENTUSEDPLASTICBAGSASASANITATIONCOPINGMECHANISMINTHEIRPOST EARTHQUAKEENVIRONMENT!PARTICULARPUBLICHEALTHCONCERNWASTHAT USEOFBAGSFORDEFECATIONINCAMPSWITHOUTEFFECTIVEWASTEMANAGE MENT AND HYGIENE PROMOTION WOULD INCREASE THE IMPACT OF @mYING TOILETSWHEREBYBAGSlLLEDWITHEXCRETAARETHROWNINTODITCHESON THEROADSIDEORSIMPLYASFARAWAYASPOSSIBLE5.$0 Bags for defecation Oxfam GB researched the applicability of standard bags and ‘Peepoos’ for defecation in two settlements in Portau-Prince There is a dearth of research on the structured applicability of bags in emergency response Waterlines Vol. 30 No. 1 !PARTICULARPROBLEMFOUNDWITHTHERANGEOFCONVENTIONALSANITATION SYSTEMSISTHEEFFECTONDIGNITYANDPROTECTIONESPECIALLYFORWOMEN CHILDREN AND ELDERLY OR DISABLED INDIVIDUALS WITH MOBILITY LIMITA TIONS !DDITIONALLY NIGHTTIME USE OF LATRINES IN )$0 SETTLEMENTS IN 0ORTAU0RINCEPARTICULARLYBYWOMENANDCHILDRENHADBEENFOUND TOBELIMITEDOWINGTOPERCEPTIONSOFINSECURITYTHELACKOFLIGHTING DISTANCETOFACILITIESANDRAINYWEATHER4HEREFOREMULTIPLEOPTIONSTO ACHIEVESAFEEXCRETADISPOSALHADTOBECONSIDERED 2ECOGNIZINGTHATDURINGANEMERGENCYRESPONSETHEAIMOFASAFE EXCRETADISPOSALSYSTEMISTOPROVIDEANDMAINTAINANENVIRONMENT FREEFROMCONTAMINATIONBYHUMANFAECES3PHEREANDKEEN TO ADD VALUE AND RAISE CRITICAL DISCUSSION ABOUT THE RANGE OF SANITA TIONOPTIONSFORURBANCONTEXTS'LOBAL7!3(#LUSTER/XFAM '"UTILIZEDPARTICIPATORYACTIONRESEARCHTOASCERTAINTHEAPPLICABILITY OFSTANDARDBAGSAND@0EEPOOSFORDEFECATIONINTHECONTROLLEDLOCA TIONOFTWOSPONTANEOUSSETTLEMENTSINTHE$ELMASSUBURBOF0ORTAU 0RINCE4ABLE 4HEREISADEARTHOFRESEARCHONTHESTRUCTUREDAPPLICABILITYOFBAGS IN EMERGENCY RESPONSE OR THE ABILITY TO IMPROVE UPON BAG USAGE THROUGH PER CENT COMMUNITY COVERAGE PROPER STORAGE MECHA NISMSADEQUATECOLLECTIONANDHYGIENEPROMOTION'IVENTHELACKOF RESEARCHONTHEAPPLICABILITYOFBAGSASPARTOFANEMERGENCYEXCRETA DISPOSAL SYSTEM THEIR MOBILIZATION IN HUMANITARIAN RESPONSE OFTEN January 2011 64 D. PATEL et al. Table 1. Research objectives Technical To gather empirical evidence on the technical ability of a structured ‘bag’ interface within a system to improve upon gaps in emergency response sanitation needs and coverage Sociocultural To ascertain the ease of understanding and ease of use of ‘bags’ for emergency excreta management, and user perspectives about hygiene, safety, dignity and privacy Programmatic To prepare recommendations on how existing practices of defecating in bags could be improved through public health promotion, solid waste collection and disposal, and provision of materials and facilities RELIES ON IMPROMPTU UPTAKE BY POPULATIONS WITHOUT ADEQUATE SUP PORT AND LITTLE TO NO DOCUMENTATION EXISTS TO RECORD THE APPROACH TAKENWHATWASSUCCESSFULORWHATWASINAPPROPRIATE'LOBAL7!3( #LUSTER7HILEANECDOTESOFINDIVIDUALANDAGENCYAPPROACHES EXIST THERE IS AN URGENT NEED FOR lELDBASED RESEARCH AND DEVELOP MENT INTO EMERGING TECHNOLOGIES AND PRAGMATIC APPROACHES TO lLL GAPSANDMEETTHECHALLENGESOFADEQUATEANDAPPROPRIATESANITATION SYSTEMSFORURBANHUMANITARIANRESPONSE 4HE@0EEPOOANEMERGINGTOILETTECHNOLOGYCREATEDBYTHE3WEDISH COMPANY0EEPOOPLEISMARKETEDASANIMPROVEMENTUPONTRADITION ALBAGSUSEDFORDEFECATION4ODATEMEDIUMSCALEFEASIBILITYSTUDIES HAVEBEENCONDUCTEDIN+ENYAAND"ANGLADESHTOGAUGETHEUSEFUL NESSOFTHE0EEPOOASANALTERNATIVEFORURBANSLUMS-UENCHETAL 4HERESULTSOFTHESTUDIESPOINTTOHIGHUSERSATISFACTIONBUT THE 0EEPOO HAD NOT BEEN TRIALLED IN AN EMERGENCY SETTING NOR IN A SITUATIONWITHMINIMALDIRECTINPUTFROMTHEIMPLEMENTINGAGENCY ASWOULDBEMOREAPPROPRIATETOANEMERGENCYSETTING Methodology Trial setting 4HETRIALWASCONDUCTEDOVERAWEEKPERIODIN!PRILn-AYIN TWOSPONTANEOUS)$0SETTLEMENTS#AMP'ARAGEAND#AMP#IT½AUX #AYESIN$ELMAS0ORTAU0RINCE4HESECAMPSWERESELECTEDFORTHE TRIALBASEDONTHECHALLENGESINASSISTINGTHECAMPS4ABLEANDAT MORETHANTWOMONTHSPOSTEARTHQUAKE)$0HADNOTRECEIVED7!3( ASSISTANCE4RIALPARTICIPANTSWERECONSULTEDPRIORTOANYINTERVENTION TOENSUREPOTENTIALSTRATEGIESIMPLEMENTEDWEREACCEPTABLE 4OSWIFTLYMEETTHENEEDSOF)$0SLOCALLYAVAILABLEBAGSGROCERY SIZEWEREPURCHASEDFORTHISTRIAL7ITHALIMITEDNUMBEROF0EEPOOS AVAILABLE THE SMALLER SETTLEMENT#AMP'ARAGEWASCHOSENTOTRIAL TWOWEEKSOFTHE0EEPOOFOLLOWEDBYTWOWEEKSOFSTANDARDBAGSAND January 2011 Waterlines Vol. 30 No. 1 EXCRETA DISPOSAL IN EMERGENCIES: HAITI 65 Table 2. Constraints to conventional emergency sanitation approaches in trial setting Camp Garage Camp Cité aux Cayes Private land owner, threat of eviction Private land owner Inability to excavate because settlement on concrete parking area around semicollapsed school Inability to excavate because only open space is adjacent to eroding ravine Density/space restrictions Extremely dense, impossible-to-reach appropriate ratio of people to toilets Landowner permission not granted to provide on-site excreta disposal of any type (elevated, porta-loo etc.) No road access, limited desludging capabilities #AMP#IT½AUX#AYESTRIALLEDFOURWEEKSOFSTANDARDBAGS!LLRESEARCH WAS SUPPORTED BY REPRESENTATIVES IN EACH CAMP AND CARRIED OUT BY LOCAL ENUMERATORS WITH ALL RESEARCH MATERIALS DRAFTED OR TRANSLATED APPROPRIATELYTO(AITIAN#REOLE Selection of trial participants .OSAMPLINGWASCONDUCTEDFORPARTICIPATIONSINCETHEAIMOFASANI TATIONSYSTEMISPERCENTPOPULATIONCOVERAGE4HENATUREOFAN )$0SETTLEMENTISSUCHTHATITISDIFlCULTTOCENSUSITCOMPLETELYBUT POPULATION CHARACTERISTICS WERE ASCERTAINED AS ACCURATELY AS POSSIBLE GIVEN THE CONSTRAINTS 0RIOR TO THE TRIAL A BASELINE CENSUS WAS CON DUCTEDINBOTHCAMPS4ABLETOENABLERANDOMSELECTIONOFPARTICI PANTSFORDATACOLLECTION Oxfam GB undertook rigorous, field-based, participatory action research within an acute emergency response Data collection /XFAM '" UNDERTOOK lELDBASED PARTICIPATORY ACTION RESEARCH THAT WASSUFlCIENTLYRIGOROUSTOBECONlDENTINDISSEMINATINGTHEOUTPUTS TOAWIDEEXTERNALAUDIENCEYETWASOPERATIONALLYFEASIBLEWITHINAN ACUTEEMERGENCYRESPONSE/XFAM'" 4HEOVERALLRESEARCHDESIGNWASINTENSIVEWITHFOURCOMPLEMENTARY DATACOLLECTIONPROCEDURESTOPROVIDEACOMPREHENSIVEREPRESENTATION OFTHESANITATIONSITUATIONEXPERIENCEDINBOTHSETTLEMENTS0RIMARY DATA WAS COLLECTED BEFORE AND AFTER THE TRIAL THROUGH HOUSEHOLD Table 3. Baseline camp census Households Population Waterlines Vol. 30 No. 1 Garage Cité aux Cayes 54 290 391 1,921 January 2011 66 D. PATEL et al. Primary data was collected before and after the trial through household questionnaires and focus group discussions QUESTIONNAIRES((1SANDFOCUSGROUPDISCUSSIONS&'$STHATWERE PRETESTEDFORACCURACYANDAPPROPRIATENESS3UPPLEMENTARYDATAWAS GATHEREDTHROUGHPARTICIPANTOBSERVATIONSCAMPINFRASTRUCTUREENVI RONMENTOBSERVATIONSANDINFORMALINTERVIEWSWITHKEYINFORMANTS &'$PARTICIPANTSWERERECRUITEDTHROUGHSIMPLERANDOMSAMPLING WITHIN GEOGRAPHIC STRATA DElNED BY LOCATION MAPPED IN CAMPS TO COVER THE ENTIRE CAMP AND AVOID VOLUNTEER BIAS 4WO EXPERIENCED ENUMERATORSOFTHESAMESEXCONDUCTEDGENDERSEGREGATED&'$SAND TOOK DETAILED NOTES 2ECORDINGS WERE TAKEN FOR TRANSCRIPTION WHEN EVERPOSSIBLE ((1S WERE ADMINISTERED ORALLY TO HEAD OF HOUSEHOLD ANDOR OTHER RESPONDENTS PRESENT AFTER CONSENT WAS RECEIVED (OUSEHOLDS WERE CHOSEN THROUGH SIMPLE RANDOM SAMPLING WITHIN GEOGRAPHIC STRATATOAVOIDVOLUNTEERBIAS)N#AMP#IT½AUX#AYESASAMPLESIZE OF HOUSEHOLDS WAS NEEDED TO HAVE A CONlDENCE LEVEL OF PER CENTWITHAPERCENTMARGINOFERROR)N#AMP'ARAGEASAMPLE SIZEOFHOUSEHOLDSWASNEEDEDTOHAVEACONlDENCELEVELOFPER CENTWITHPERCENTMARGINOFERROR!CTUALSAMPLINGWASLARGERIN BOTHCAMPSTOCOMPENSATEFORREFUSALSORHOUSEHOLDSWITHOUTANYONE home. Data analysis /BSERVATIONSWERERECORDEDDAILYANDPROVISIONALLYCODEDACCORDING TOEMERGINGTHEMESTOIDENTIFYGAPSINANALYTICISSUESTOEXPLOREDUR INGSUBSEQUENTMOREFOCUSEDDATACOLLECTION&'$SWERETRANSCRIBED TO%NGLISHANDCODEDACCORDINGTOSALIENTTHEMES((1SWEREENTERED IN%XCELANDANALYSEDUSINGSTATISTICALTOOLS Sanitation system design 4O TEST THE REQUIREMENTS FOR BAGS TO BE PART OF AN APPROPRIATE AND ADEQUATESANITATIONSYSTEMINEMERGENCYCONTEXTSSIXKEYAREASWERE EXAMINEDUSERINTERFACEDISTRIBUTIONDEPOSITANDSTORAGE COLLECTIONANDTRANSPORTTREATMENTORDISPOSALANDHYGIENEPRO MOTION&EEDBACKFROMPRETRIAL&'$SANDKEYINFORMANTINTERVIEWS WASINCORPORATEDINTOTHEDESIGNOFEACHSTEP User interface. )NHOME AND COMMUNITY INTERFACE OPTIONS WERE PRO VIDEDINBOTHCAMPSTOOFFERPARTICIPANTSFREEDOMOFCHOICEFORTOILET ACCESS)N#AMP#IT½AUX#AYESINHOMEPROVISIONCONSISTEDOFONE COMMONLYAVAILABLERECYCLEDCONTAINERT-maliceBUCKETPERHOUSE HOLDANDBAGS#OMMUNALCABINSWITHPREFABRICATEDCOMMODESWERE ERECTED AS PART OF HYGIENE UNITS AT THE PERIMETER OF THE CAMP GEO GRAPHICALLYSEGREGATEDBYGENDER)N#AMP'ARAGEINHOMEPROVISION CONSISTEDOFONEAPPROPRIATELYSIZEDBUCKETPURCHASEDNEWATALOCAL January 2011 Waterlines Vol. 30 No. 1 EXCRETA DISPOSAL IN EMERGENCIES: HAITI Commode with bucket to hold a Peepoo in communal cabin, Camp Garage 67 Household kit creation (T-malice bucket with bags and IEC material) and distribution in Camp Cité aux Cayes MARKETPERHOUSEHOLDAND0EEPOOS#OMMUNALCABINSWEREERECTED ONTHEROADTHATINTERSECTEDTHECAMPTOCONTAINPREFABRICATEDCOM MODESWITHSPECIALLYWELDEDBUCKETSCREATEDIN(AITISIZEDTOHOLD A0EEPOO 7ITHALIMITEDNUMBEROF0EEPOOSAVAILABLEFORTHETRIALANDTODE CREASEBAGWASTEMALEANDFEMALEURINALSWEREALSOPROVIDEDINBOTH CAMPS5RINALSWEREPLACEDWITHINSUPERSTRUCTURESFORADDEDPRIVACY WHICHBASEDONPRETRIALDATAWASFOUNDTOBEIMPORTANTESPECIALLY FORWOMEN One bag or Peepoo per person per day for a week’s supply were distributed to households along with IEC materials Distribution. $URINGTHElRSTWEEKOFTHETRIALHOUSEHOLDDISTRIBUTION WASUNDERTAKENUTILIZINGPREPACKAGED@KITS/NEBAGOR0EEPOOPER PERSONPERDAYFORAWEEKSSUPPLYWEREPLACEDINSIDETHERESPECTIVE CONTAINERS AND DISTRIBUTED TO HOUSEHOLDS ALONG WITH INFORMATION EDUCATIONANDCOMMUNICATION)%#MATERIALS&ORTHEREMAINDEROF THE TRIAL CABIN ATTENDANTS AND CAMP COMMITTEE MEMBERS HANDLED WEEKLYHOUSEHOLDDISTRIBUTIONBASEDONTHENEEDSOFHOUSEHOLDS Deposit and storage. )N #AMP #IT½ AUX #AYES USED BAGS WERE TO BE DEPOSITEDINGALLONDRUMSWITHLIDSLOCATEDBEHINDTHEMALEAND Waterlines Vol. 30 No. 1 January 2011 68 D. PATEL et al. Drums with lids located by communal cabins to safely deposit bags filled with excreta Used Peepoos being composted outside Port-au-Prince FEMALEHYGIENEBLOCKS$UETODENSITYOFTHESHELTERSANDINABILITYTO ACCESSMANYAREASADDITIONALEXCRETADEPOSITDRUMSWERENOTPLACED AROUND THE CAMP )N #AMP 'ARAGE GALLON DEPOSIT DRUMS WITH LIDSWEREPROVIDEDNEARTHECABINSANDINOTHERLOCATIONSAROUNDTHE CAMP)NBOTHCAMPSTOSTEMTHE@mYINGTOILETPRACTICEANDENCOUR AGEPROPERCOLLECTIONTRIALPARTICIPANTSWEREINSTRUCTEDTHATDEPOSIT DRUMSWEREEXCLUSIVELYTOCOLLECTUSED0EEPOOSORBAGS Deposit drums filled with Peepoos were transported to a composting site in a suburb of Port-auPrince Hygiene promotion is an integral component to bag excreta disposal systems to ensure proper usage and collection January 2011 Collection and transport for treatment or disposal. $EPOSIT DRUMS WERE TRANSPORTED BY WHEELBARROW -ONDAYn3ATURDAY TO THE NEAREST ROAD ACCESS OUTSIDE OF #AMP #IT½ AUX #AYES FOR COLLECTION BY A (AITIAN COMPANY HANDLING EXCRETA DISPOSAL $RUMS WERE EMPTIED INTO THE COMPANYS TRUCK AND COMBINED WITH EXCRETA COLLECTION FROM OTHER CAMPSTOBEDISCARDEDATANEXCRETASPECIlCPITIN4RUTIERINLINEWITH CURRENTPRACTICESBYOTHERORGANIZATIONS $EPOSITDRUMSlLLEDWITH0EEPOOSWERECOLLECTED-ONDAYn3ATURDAY FROM#AMP'ARAGEONAmATBEDTRUCKANDTRANSPORTEDTOACOMPOSTING SITERUNBY.EW$IRECTIONS&OUNDATIONINASUBURBOF0ORTAU0RINCE 7HEN #AMP 'ARAGE PARTICIPANTS SWITCHED TO BAGS THEIR COLLECTION WASAPPENDEDTOTHECOLLECTIONFROM#AMP#IT½AUX#AYES $RUMSWERENOTCOLLECTEDON3UNDAYSBECAUSEITISAHOLIDAYIN(AITI 4HERE WERE ALSO OCCASIONS ON WHICH THE EXCRETA DRUMS COULD NOT BE PICKEDUPEGHEAVYRAINSBLOCKEDROADACCESSTOTHECAMPS4HElLLED DRUMSREMAINEDINTHECAMPANDWEREKEPTCOVEREDSOVECTORANDSMELL CONTROLWASMAINTAINED4HEREWASNORESISTANCEFROMCAMPLEADERSOR RESIDENTSWHENTHESEEXCEPTIONALCIRCUMSTANCESOCCURRED Hygiene promotion. (YGIENEPROMOTIONISANINTEGRALPROGRAMMECOM PONENTTOBAGEXCRETADISPOSALSYSTEMSTOENSUREPROPERUSAGECOLLEC TION AND REMOVAL OF BAGS )%# MATERIALS WERE SPECIlCALLY DRAFTED FOR THE 0EEPOO AND BAG SYSTEMS AND PRETRIALLED FOR CULTURAL SENSITIVITY Waterlines Vol. 30 No. 1 EXCRETA DISPOSAL IN EMERGENCIES: HAITI 69 AND EASE OF UNDERSTANDING THROUGH &'$S AND KEY INFORMANT REVIEW (AITI7!3(#LUSTERCAMPCOMMITTEES/NGOINGHYGIENEPROMOTION MESSAGESINCLUDEDEDUCATIONONTHEIMPORTANCEOFSEGREGATINGEXCRETA FROM GENERAL SOLID WASTE THE REASONING BEHIND SEPARATE URINAL AND TOILETSPROVISIONSDISPOSALOFCHILDRENSEXCRETAVECTORCONTROLPROVID ED BY CLOSING LID ON EXCRETA DEPOSIT DRUMS AND HANDWASHING WITH SOAP)NBOTHCAMPSHANDWASHINGFACILITIESANDSOAPWEREPROVIDED Results and discussion !NALYSISOFKEYRESULTSFROMTHE((1SAND&'$SSUMMARYIN4ABLE PERTAININGTOTHEPOTENTIALTOUTILIZEBAGSFOREXCRETADISPOSALINURBAN HUMANITARIAN SITUATIONS ARE DISCUSSED BELOW .OTE FEWER POSTTRIAL ((1S WERE COMPLETED IN #AMP 'ARAGE BECAUSE A LARGER PERCENTAGE OFHOUSEHOLDSHADRETURNEDTOWORKORSCHOOLBY-AYWHENTHE ((1SWERECONDUCTED Pre-trial None of the participants stated they defecated in bags prior to the earthquake Pre-earthquake facilities. 0ARTICIPANTS PREEARTHQUAKE TOILET SITUATION WASASCERTAINED&IGURE)NCONTRASTTOTHEANECDOTALINFORMATION AVAILABLENO((1OR&'$PARTICIPANTSTATEDTHEYDEFECATEDINBAGS PRIORTOTHEEARTHQUAKE4HISMAYBEDUETOTHEPERSPECTIVETAKENBY RESPONDENTS WHEN ANSWERING QUESTIONS &OR EXAMPLE MANY HOUSE HOLDS DID NOT STATE THEY @DEFECATE IN THE OPEN DURING THE ADMINIS TRATIONOFTHEPRETRIAL((1BECAUSETHEYCONSIDERDEFECATINGINTOA RAVINEASADIFFERENTCONCEPTADESIGNATEDSPOT 5PONOBSERVATIONITWASFOUNDTHATTHEHIGHPERCENTAGEOFHOUSE HOLDSWHOSTATEDTHEYHADmUSHTOILETSPERCENTCOMPAREDWITH *-0DATAPERCENT7(/5.)#%&ISDUETOTHEFACTTHAT MANYOFTHERESPONDENTSPREVIOUSLYLIVEDINHOUSESTHATWEREALONG ARAVINEANDHADTOILETSTHATDIRECTLYEMPTIEDINTOTHERAVINEWHEN Table 4. Summary of data collection Pre-trial Post-trial FGDs Garage Cité aux Cayes Female 3 8 Male 2 6 Female 3 6 Male 3 7 HHQs Garage Cité aux Cayes Complete 43 109 HH empty 2 67 completed 31 115 HH empty 133 65 3 &EWERPOSTTRIAL((1SWERECOMPLETEDBECAUSEALARGERPERCENTAGEOFHOUSE HOLDS HAD RETURNED TO WORK OR SCHOOL BY -AY WHEN THE ((1S WERE conducted. Waterlines Vol. 30 No. 1 January 2011 70 D. PATEL et al. No facility 5% Indoor flush 30% Outdoor pit latrine 34% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 43% 24% 13% 6% Security concerns at night Indoor pit latrine 30% Figure 1. Type of facility primarily used preearthquake 14% Proper Freedom of Have no Difficulty collection access (time, other toilet accessing will make location, pre-EQ toilet camp cleaner privacy) (night, rain, emergencies) Figure 2. Why household is interested in using a Peepoo or bag in home mUSHED4HISISNOTCONSIDEREDANIMPROVEDSANITATIONSYSTEM/FTHE HOUSEHOLDSWHOHADACCESSTOTOILETSPRIORTOTHEEARTHQUAKE PERCENTSHAREDTHEFACILITYWITHOTHERHOUSEHOLDS Post-earthquake toilet options. !FTERTHEEARTHQUAKEHOUSEHOLDSREPORT EDDEFECATINGASFOLLOWSINPERCENTOFHOUSEHOLDSONEORMORE MEMBERSUSEDPLASTICBAGSINPERCENTOFHOUSEHOLDSONEORMORE MEMBERSRETURNEDTOPREEARTHQUAKEHOUSESINPERCENTOFHOUSE HOLDSONEORMOREMEMBERSDEFECATEDINTHEOPENINPERCENTOF HOUSEHOLDSONEORMOREMEMBERSDEFECATEDINTOCONTAINERSANDIN PERCENTOFHOUSEHOLDSONEORMOREMEMBERSUSEDAFACILITYBYTHEIR WORKPLACE&URTHERMOREINHOUSEHOLDSWHERETHEADULTSWEREUTILIZ ING TOILETS AT THEIR WORKPLACE OR RETURNING TO EARTHQUAKEDAMAGED BUILDINGSPERCENTOFTHECHILDRENFROMTHOSEHOUSEHOLDSWERE DEFECATING IN THE OPEN OR INTO BUCKETS AND THE EXCRETA WAS THROWN INTONEARBYOPENAREAS Women spoke about how ‘shame’ drove them to defecate at night and there were cases of sexual abuse January 2011 Experience with bags. "ASELINEDATACOLLECTIONCONlRMEDTHEPERCEIVED WIDESPREAD USE OF BAGS FOR DEFECATION AMONGST )$0 AFTER THE EARTH QUAKE/FTHEPERCENTOFHOUSEHOLDSWITHONEORMOREMEMBERS USINGBAGSFORDEFECATIONTHELOCATIONUSEDTODEFECATEWASNOTSPECI lEDINHOMEOROTHERBUTPERCENTOFRESPONDENTSSTATEDTHEY DISCARDEDTHEBAGININDISCRIMINATELOCATIONS )N #AMP #IT½ AUX #AYES FEMALE &'$ PARTICIPANTS DISCUSSED WHY THEYCHOSEBAGSOVEROPENDEFECATION4HOSEWHOCOULDNOTlNDBAGS ORAFFORDTOBUYTHEMWEREFORCEDTOGOTOTHERAVINETODEFECATEIN THEOPEN7OMENSPOKEABOUTHOW@SHAMEDROVETHEMTODEFECATEAT NIGHTANDTHEREWERECASESOFWOMEN@BEINGSNATCHEDFROMBEHIND ANDGETTINGSEXUALLYABUSED!SWORDSPREADAROUNDTHECAMPWOMEN Waterlines Vol. 30 No. 1 EXCRETA DISPOSAL IN EMERGENCIES: HAITI Overall, 49 per cent of households were interested in using a Peepoo or bag as a toilet in their homes 71 BEGANDEFECATINGINTHERAVINEINTHEMORNINGINSTEAD(OWEVERTHIS RESULTEDINTHEWOMENFALLINGPREYTOADIFFERENTTYPEOFABUSEPEOPLE WOULDTHROWROCKSATTHOSESQUATTINGINTHERAVINEANDSCREAMEPI thets at them. /VERALLPERCENTOFHOUSEHOLDSWEREINTERESTEDINUSINGA0EEPOO ORBAGASATOILETINTHEIRHOMESFORVARIOUSREASONS&IGUREANDNO HOUSEHOLDSEXPRESSEDAVERSIONTOUSINGABAGFOREXCRETACONTAINMENT INACOMMUNALCABININTHECAMP Post-trial The Peepoo was preferred for in-home use because of its ability to contain odour 4HE/XFAM'"BAGSANITATIONSYSTEMWASTHEPRIMARYTOILETUTILIZEDBY PERCENTOFHOUSEHOLDS/FTHEHOUSEHOLDSTHATUSEDBAGSEITHERIN THEIRHOMEORINTHECABINSPERCENTSTATEDTHEYARE@VERYSATISlED OR @SATISlED WITH THE SYSTEM 4HERE WAS ALSO A SIGNIlCANT REDUCTION IN SAFETY DIGNITY AND PRIVACY ISSUES POSTTRIAL &IGURE #OMPARING FACILITIESUTILIZEDBEFOREANDAFTERTHE/XFAM'"INTERVENTIONPRETRIAL PERCENTOFHOUSEHOLDSRETURNEDTOEARTHQUAKEDAMAGEDHOMESTO DEFECATEWHEREASPOSTTRIALONLYPERCENTREPORTEDDOINGSO.OOPEN DEFECATIONWASREPORTEDPOSTTRIAL 4HERE WAS A SIGNIlCANT REDUCTION IN SELFREPORTED DIARRHOEA PRE TRIALPERCENTOFHOUSEHOLDSEXPERIENCEDDIARRHOEAINTHEPREVIOUS TWOWEEKSWHILEPOSTTRIALONLYPERCENTEXPERIENCEDDIARRHOEAIN THEPREVIOUSTWOWEEKSFP Figure 3. Problems faced when defecating, pre- and post-trial Waterlines Vol. 30 No. 1 January 2011 72 D. PATEL et al. Odour. &OR INHOME USE IN #AMP 'ARAGE PARTICIPANTS SIGNIlCANTLY FAVOUREDTHE0EEPOOPERCENTCOMPAREDWITHABAGPERCENT FP(OWEVERTHEPREFERENCEFORHOUSEHOLDSTODEF ECATEINTHEPRIVACYOFTHEIRHOMEESPECIALLYATNIGHTWASENOUGHFOR ANADDITIONALPERCENTOFHOUSEHOLDSTOSTATETHEYWOULDUSEBAGS ASTOILETSINTHEIRHOME@IFITWASANEMERGENCY#OPINGMECHANISMS AGAINST ODOUR INCLUDED PLACING USED BAGS DIRECTLY OUTSIDE THE TENT ORINACONTAINERWITHATIGHTlTTINGLID/FTHEHOUSEHOLDSWHO STATEDTHEYDONOTUSETHEBAGSINTHEIRHOMEATALLNINEPERCENT DIDUSE0EEPOOSINTHEIRHOME )NEVERY#AMP'ARAGE&'$THEREWASACONSENSUSTHATTHE0EEPOO WASPREFERREDFORINHOMEUSEBECAUSEOFITSABILITYTOCONTAINODOUR )NONE&'$AWOMENSTATED@YOUCOULDLEAVEA;USED=0EEPOOONTHE STREETFORAWEEKANDEVENTHEPIGSWOULDNTKNOWITISTHERE3OME PEOPLEALSOSTATEDTHEYKEPTEXTRA0EEPOOSTHEYHADFROMTHElRSTHALF OFTHETRIALSOLELYFORINHOMEUSEANDUSEDTHECABINSDURINGTHEDAY WITHTHEOTHERBAG )N #AMP #IT½ AUX #AYES PER CENT OF HOUSEHOLDS USED BAGS IN THEIR HOME /F THE HOUSEHOLDS WHO STATED THEY DO NOT USE BAGS IN THEIRHOMEPERCENTCHOSETODOSOBECAUSETHEYPREFERTHECABINS ORHAVEOTHERTOILETOPTIONS/NLYPERCENTSTATEDTHEYDIDNOTUSE bags in their home because of the odour. Difficulties in using the Peepoo included inadequate circumference to spread it over a container and inadequate length to knot after use With children, disabled people, or in urgent situations, the standard bag was preferred because of the ease of use January 2011 Ease of use. 4HEREWASACONSENSUSAMONGPOSTTRIAL&'$PARTICIPANTS ONTHEDIFlCULTYINUSINGTHE0EEPOOFORTWOMAINREASONSINADEQUATE CIRCUMFERENCETOSPREADTHE0EEPOOOVERACONTAINERANDINADEQUATE LENGTHWHICHINHIBITEDPROPERKNOTTINGAFTERUSE!MAJORITYOFADULTS STATEDIFITWASNOTURGENTIMMEDIATEONSETOFDESIRETODEFECATETHEY WEREABLETOUSETHE0EEPOOWITHOUTTOOMUCHDIFlCULTY2ESPONDENTS STATEDTHEYALSOCOPEDBYKEEPING0EEPOOSALREADYOPENINTHECOM MUNALCOMMODES (OWEVER WITH CHILDREN DISABLED PEOPLE OR IN URGENT SITUATIONS THESTANDARDBAGWASPREFERREDBECAUSEOFTHEEASEOFUSE#ARETAKERS REPEATEDLYSTATEDTHATTHEPREPARATIONTIMEREQUIREDTOUSETHE0EEPOO WASAHINDRANCEWHEREASWITHABAGTHEYCOULD@QUICKLYOPENITON THEmOORFORAPERSONTOSQUATOVER4HE&'$WITHLATRINEATTENDANTS REVEALEDTHATTHEYPREFERREDTHEBAGTOTHE0EEPOOBECAUSE@TOOMANY USERSHADTROUBLEPROPERLYOPENINGTHE0EEPOOINTHECOMMODEAND ITWOULDCAUSEFAECESTOFALLINTOTHEBOWL #ONTAINERSWEREPROVIDEDTOHOUSEHOLDSFOREASEOFUSEOFTHEBAGS 0OSTTRIAL((1DATASHOWSASIGNIlCANTDIFFERENCEINTHENEEDFORA CONTAINER FOR BAGS ONLY PER CENT OF BAG USERS STATED THEY USED A CONTAINER THAN FOR THE 0EEPOO PER CENT USED A CONTAINER F P 4HE NEED FOR A CONTAINER WITH STANDARD BAGS MAYBEEVENLESSCONSIDERINGTHATOFTHEHOUSEHOLDSINTHEPRETRIAL Waterlines Vol. 30 No. 1 EXCRETA DISPOSAL IN EMERGENCIES: HAITI 73 ((1 WHO STATED THEY DEFECATED IN BAGS N ONLY PER CENT used a container. Utilization of ‘improved aspects’ of bag excreta disposal system Daily observations of collected Peepoos revealed there were multiple incidences of improper use 7ITH THE BAG #IT½ AUX #AYES PARTICIPANTS UNANIMOUSLY STATED PRE TRIALPERCENTANDPOSTTRIALPERCENTTHATTHE)%#MATERIAL PROVIDED WAS SUFlCIENT FOR THEM TO PROPERLY UTILIZE THE BAG EXCRETA DISPOSALSYSTEM!LTHOUGHPERCENTOFPRETRIAL((1RESPONDENTS STATEDTHEYCOULDEASILYFOLLOWTHEDIRECTIONSOFTHE0EEPOOINSTRUC TIONSHEETPRETRIAL&'$RESPONDENTSUNANIMOUSLYEXPRESSEDANEED FORDEMONSTRATIONSONHOWTOUSETHE0EEPOO$AILYOBSERVATIONSOF COLLECTED0EEPOOSREVEALEDTHEREWEREMULTIPLEINCIDENCESOFIMPROP ERUSEINNERSEALNOTOPENEDGREENLINERWITHFAECALMATTERPRESENT WAS NOT TUCKED INTO OUTER WHITE LAYER BEFORE KNOTTING 0EEPOO NOT KNOTTEDATALLANDREPEATEDDEMONSTRATIONSOVERTHElRSTWEEKOFTHE TRIALWERENECESSARY"YTHEENDOFTHESECONDWEEKNONCOMPLIANCE WITHNECESSARYSTEPSTOUSINGTHE0EEPOOWASSTILLPRESENTINAPPROXI MATELYPERCENTOFCOLLECTED0EEPOOS !LL((1RESPONDENTSFROMBOTHCAMPSSTATEDTHEYDEPOSITEDUSED BAGSINPROPERCOLLECTIONRECEPTACLES(OWEVERIN#IT½AUX#AYESIN OUTOFPOSTTRIAL&'$STHEREWERESTATEMENTSTHATPEOPLEHAD OBSERVEDOTHERSTHROWEXCRETAlLLEDBAGSONTOSOMEONEELSESTENT )NDAILYOBSERVATIONSUNDERTAKENBYRESEARCHERS/XFAMDISTRIBUTED BAGS WERE VISIBLY THROWN INTO THE RAVINE DURING THE lRST WEEK OF THETRIALBUTNEVERINDISCRIMINATELYAROUNDTHECAMP!FTERTHElRST WEEKLATRINEATTENDANTSANDCAMPVOLUNTEERSCONDUCTEDASUPERl CIALCLEANINGOFTHERAVINEEDGEANDSUBSEQUENTLYMORETHANPER CENTOFDEFECATIONBAGSWEREPROPERLYDISCARDED Limitations This trial occurred in a socio-cultural setting with a preemergency history of bag usage for defecation Waterlines Vol. 30 No. 1 4HOUGHTRIALLEDINTWOMARKEDLYDIFFERENT)$0SETTLEMENTSTHISTRIAL OCCURREDINASOCIOCULTURALSETTINGWITHAPREEMERGENCYHISTORYOF BAG USAGE FOR DEFECATION 4HEREFORE CAUTION MUST BE TAKEN WHEN UTILIZINGTHISAPPROACHINOTHERSOCIOCULTURALCONTEXTS 4HOUGHTHEMETHODOLOGYUTILIZEDOBJECTIVEOBSERVATIONSTHEMA JORITYOFTHEDATAGATHEREDDURINGTHETRIALCOMESFROMSELFREPORTING ((1S WERE ADMINISTERED AS INTERVIEWS AND CONSEQUENTLY MAY BE SUBJECTTOENUMERATORINTERPRETATION/XFAM'"ATTEMPTEDTOREDUCE THEEFFECTOFINTERPRETATIONANDVARIABILITYBETWEENQUESTIONNAIREAD MINISTRATIONBYTRAININGALLENUMERATORSTOGETHERANDHAVINGTHEM SHARE THEIR ADMINISTRATION STRATEGY 4HERE WAS ONE CASE IN THE #IT½ AUX #AYES PRETRIAL ((1 IN WHICH AN ENUMERATOR WHO COMPLETED ((1SINCORRECTLYPRESENTEDTHEQUESTIONOFUSINGABAGINHOME AS AN EITHEROR SITUATION TO USING THE BAG IN THE CABIN WHICH LIKELY January 2011 74 D. PATEL et al. RESULTEDINFALSENEGATIVESFORHOUSEHOLDSINTERESTEDINUSINGBAGSIN their home. Conclusions This trial supports bags and Peepoos as viable in the compendium of excreta disposal options Once the bags were deposited in collection drums and the lid closed, nearly all stated there was no smell or flies January 2011 $ESPITETHELIMITATIONSMENTIONEDABOVETHERESULTSOFTHISTRIALREP RESENTING TWO DIFFERENT )$0 SETTLEMENT CONTEXTS SUPPORTS BAGS AND 0EEPOOS AS VIABLE IN THE COMPENDIUM OF EXCRETA DISPOSAL OPTIONS ESPECIALLYINCOMPLEXURBANHUMANITARIANSITUATIONS4HEUSEOFBAGS IN EMERGENCY EXCRETA MANAGEMENT IS APPROPRIATE AND WELLADAPTED FORANIMMEDIATEINTERVENTIONATTHEHOUSEHOLDLEVELUNTILCOM MUNITYTOILETSCANBEPROVIDEDASHORTINTERVENTIONBEFOREPROPER LATRINESAREBUILTSETTLEMENTSWITHCHRONICSPACEORLANDUSELIM ITATIONS SETTLEMENTS WHERE DESLUDGING IS DIFlCULT OR IMPOSSIBLE ANDPOPULATIONSWHERECERTAINGROUPSWOMENCHILDRENDISABLED PEOPLEPREFERTODEFECATEINPERSONALSHELTERS 0RETRIAL DATA HIGHLIGHT UNIQUE ASPECTS OF URBAN EMERGENCIES AND THECOPINGMECHANISMSPEOPLEADOPT4HEIMPLEMENTATIONMETHOD OLOGYINBOTHLOCATIONSIMPROVEDEXCRETACONTAINMENTANDREMOVAL IN HARDTOREACH SETTLEMENTS AND COVERED GAPS IN SANITATION ACCESS ANDACCEPTABILITYAMONGVULNERABLEPOPULATIONS3IMULTANEOUSLYTHE APPROACH WAS mEXIBLE ENOUGH TO BE IMPLEMENTED RAPIDLY AND WAS ABLE TO BE COMMUNITYMANAGED WITH MINIMAL /XFAM '" SUPPORT EG THROUGH SCALEDDOWN MAINTENANCE AND HYGIENE MESSAGING TO FACILITATEBEHAVIOURCHANGE 4RIAL DATA DEMONSTRATES THE IMPORTANCE OF COUPLING COMMUNITY LEVELANDHOUSEHOLDLEVELSANITATIONACCESSINEMERGENCIESESPECIALLY INDENSESETTLEMENTSANDTHOSEWITHSECURITYRISKS4HISLEADSTOTHE CONCLUSION THAT THERE IS A SEPARATE APPLICABILITY FOR THE 0EEPOO AND OTHER BAGS /VERALL #AMP 'ARAGE TRIAL PARTICIPANTS APPRECIATED THE 0EEPOO OVER STANDARD BAGS BECAUSE OF ITS ABILITY TO CONTAIN ODOUR 0ARTICIPANTSINBOTHCAMPSSTATEDTHATSTANDARDBAGSDONOTCONTAIN ODOUR (OWEVER ONCE THE BAGS WERE DEPOSITED IN COLLECTION DRUMS AND THE LID CLOSED NEARLY ALL PARTICIPANTS STATED THAT THERE WAS NO SMELL NO mIES AND THEIR ACTUAL TOILET INTERFACE BUCKET IN HOME OR COMMUNALCOMMODEREMAINEDCLEAN 4HEREFORE IN A SIMPLE COMPARISON OF A BAG TO THE 0EEPOO BOTH PROVEDUSEFULTOPARTICIPANTSINTHISTRIALFORDIFFERENTREASONS4HERE SULTSDEMONSTRATETHATINACOMPARISONOFABAGWITHTHE0EEPOOTHE IMPROVEMENTOFTHE0EEPOOINCONTAININGSMELLISNOTAMAJORFACTOR WHENPROPERCOLLECTIONMECHANISMSAREINPLACE)FUSEDBAGSOFANY TYPEAREKEPTINACLOSEDRECEPTACLEANDREMOVEDFROMTHECAMPOR PROPERLYDISPOSEDOFONSITEWITHRELATIVEFREQUENCYUSERSARELIKELYTO BECOMFORTABLEWITHANYTYPEOFBAG Waterlines Vol. 30 No. 1 EXCRETA DISPOSAL IN EMERGENCIES: HAITI 75 Recommendations !STHISISTHElRSTTIMETHE0EEPOOHASBEENEMPLOYEDINANEMERGENCY SITUATION/XFAM'"FEELSTHEVALUEOFUTILIZING0EEPOOSINEMERGENCY SITUATIONSCANNOTBEREALIZEDUNTILCERTAINPRODUCTIMPROVEMENTSARE IMPLEMENTED RENDERING THE 0EEPOO MORE mEXIBLE IN ITS APPLICATION ANDPRACTICALINITSUTILIZATION Specific technical recommendations on the Peepoo Oxfam GB recommends the Peepoo is enlarged to facilitate ease of use in emergency situations Size4HE0EEPOOMUSTBEENLARGEDINORDERTOFACILITATEEASEOFUSEIN EMERGENCYSITUATIONS/XFAM'"RECOMMENDSTHEINNERGREENFOILOF THE0EEPOOBEEXPANDEDFROMITSCURRENTCMCIRCUMFERENCETOAT LEASTCMSOITISMOREEASILYADAPTABLETOLOCALLYAVAILABLECONTAIN ERSINAVARIETYOFSETTINGS4HEEASEOFUSESHOULDDECREASETHEUSER EDUCATIONANDBEHAVIOURCHANGEREQUIREMENTSNECESSARYTOEMPLOY 0EEPOOSRAPIDLYINEMERGENCIES !S A SELFKNOTTING BAG COMPARED WITH HANDLES ON STANDARD BAGS THEDIFlCULTYINKNOTTINGTHE0EEPOODECREASESORELIMINATESITSABILITY TOBREAKDOWNPATHOGENS/XFAM'"RECOMMENDSTHELENGTHOFTHE 0EEPOOBEINCREASEDFROMCMTOATLEASTCMSOTHATKNOTTINGTHE 0EEPOOAFTERUSEISEASIERANDDECREASESTHECHANCEOFNONCOMPLIANCE ACCIDENTSORKNOTTINGRESULTINGINEXCRETAABOVETHEKNOT 0RODUCT SPECIlCATIONS $URING THE TRIAL THERE WAS A STRONG DETECTABLE ODOUR WHEN MANY USED 0EEPOOS WERE STORED TOGETHER AND APPROXI MATELY PER CENT OF 0EEPOOS USED WERE FOUND TO HAVE SMALL TEARS WHERETHEOUTERLAYERISWELDEDTOTHEINNERLAYERRESULTINGINLEAKAGE OFEXCRETAAFTERUSE)TISUNCLEARIFTHISWASAMANUFACTURINGDEFECTOR ARESULTOFTHELENGTHOFTIMEELAPSEDSINCEPRODUCTION /XFAM '" RECOMMENDS 0EEPOOPLE EXAMINE THE PERIOD OF TIME BETWEENPRODUCTIONANDUSETHATTHE0EEPOOMATERIALREMAINSEFFEC TIVE!DDITIONALLYIFTHE0EEPOOORBIODEGRADABLEBAGSARETOBEUSED AS CONTINGENCY STOCK FOR EMERGENCY PREPARATION IT IS NECESSARY TO ACCOUNTFORTHESHELFLIFEOFTHEMATERIALANDTHENECESSARYSTORAGE REQUIREMENTSSUCHASTEMPERATUREMOISTUREANDPROPERHANDLING Key programmatic recommendations Both standard bags and Peepoos are viable options in first phase emergency response Waterlines Vol. 30 No. 1 "OTH STANDARD BAGS AND0EEPOOSAREVIABLEOPTIONSASPARTOFWIDER EXCRETADISPOSALSYSTEMSINlRSTPHASEEMERGENCYRESPONSE s s 4HE 0EEPOO IS ADVANTAGEOUS FOR USE IN SHELTERS SINCE ODOUR IS MINIMALTHEREFOREPROVIDINGUSERSmEXIBILITYTODEPOSITUSEDBAGS INCOMMUNALRECEPTACLES 0ROPERBAGDEPOSITANDREMOVALISCRUCIALANDWITHTHISANYBAG TYPEMAYBEEQUALLYACCEPTABLEFORUSE January 2011 76 D. PATEL et al. s s s "AGTYPEHASNOAFFECTONACCEPTANCEOFACOMMUNALSETUP 4HE HYGIENE PROMOTION COMPONENT OF BAG EXCRETA SYSTEMS IS ESSENTIALTOENSURINGCONTINUEDSAFETYANDEFlCACYOFTHESYSTEM #URRENT COPING MECHANISMS IN DISASTERPRONE AREAS SHOULD BE EXAMINEDTODESIGNRAPIDDEPLOYMENTBAGEXCRETADISPOSALCON TINGENCYPLANSASPREPARATIONFOREMERGENCYRESPONSE Further study Further study is needed, especially in emergencies with high diarrhoea prevalence, into the number of bags to be distributed If the Peepoo or bags are to be utilized to scale in emergencies, their cost-effectiveness should be compared with other options January 2011 /WINGTOTHELIMITEDNUMBEROF0EEPOOSAVAILABLETHEMETHODOLOGY OFDISTRIBUTINGONEBAGPERPERSONPERDAYWASUTILIZED(OWEVERFUR THERSTUDYISNEEDEDESPECIALLYINEMERGENCIESWITHHIGHDIARRHOEA PREVALENCEINTOTHENUMBEROFBAGSTOBEDISTRIBUTEDTOBALANCEBE TWEEN EXCESSIVE TO PREVENT MISUSE OF BAGS EG FOR PURPOSES OTHER THANDEFECATIONANDINSUFlCIENTTOENSUREPOPULATIONSDONOTHAVE TORELYONOTHERUNSAFEMETHODSOFDEFECATION !DDITIONALLYINSETTLEMENTSUTILIZING0EEPOOSTHEBENElTOFRAPID PATHOGENDEGRADATIONOVEROTHERBAGSCANNOTBEENSUREDUNLESS PER CENT COVERAGE IS MAINTAINED !CCORDINGLY IT MUST BE ENSURED THAT THE AVAILABILITY OF 0EEPOOS FOR ALL POTENTIAL USERS IN THE AREA IS ACHIEVED OR PEOPLE MAY PICK UP THE BEHAVIOUR OF DEFECATING IN BAGS WITHOUT THE ADDED BENElT OF BIODEGRADATION OR PATHOGEN RE DUCTION #ONSEQUENTLY THIS WILL REQUIRE A MORE ROBUST METHOD OF DISTRIBUTION AND MONITORING WHICH IN LARGE CAMPS MAY BE LABOUR INTENSIVE!LTERNATIVEMETHODSTOREACHTHEENTIREPOPULATIONMUST BEDEVELOPED 4HOUGHCOSTWASNOTANALYSEDINTHISTRIALIFTHE0EEPOOORBAGSARE TOBEUTILIZEDTOSCALEINEMERGENCIESITISESSENTIALTOFURTHEREXAMINE THECOSTOVERTHEPERIODOFTIMEUTILIZEDCOMPAREDWITHOTHEROPTIONS !SAlRSTPHASEEMERGENCYSANITATIONSYSTEMCOSTOFBAGSWOULDHAVE FEWERIMPLICATIONS(OWEVEROVERTIMETHECOSTEFFECTIVENESSOFTHE SOLUTIONDECREASESINCOMPARISONWITHOTHERSYSTEMSANDTHEREFORE APROPERPHASEOUTSTRATEGYMUSTBEDEVELOPEDBYANYORGANIZATION DEPLOYINGBAGSANITATIONSYSTEMS 4HEREUSEOF0EEPOOSORCOMPOSTEDBIODEGRADABLEBAGSASFERTILIZER WASNOTANALYSEDINTHISTRIAL&URTHERRESEARCHISRECOMMENDEDINTO THEABILITYANDWILLINGNESSTOPAYFORSANITATIONTOINCREASESUSTAIN ABILITYANDWHETHERTHEREISANADVANTAGESOCIOCULTURALANDlNAN CIALORABILITYTOMANAGETECHNICALLYANDLOGISTICALLYTHEAGRICULTURAL REUSEOFHUMANFAECESINVARIOUSPOSTEMERGENCYPHASES &INALLYFURTHERRESEARCHISNEEDEDINTOTHE@PHASEOUTPOINTOFBAGS INPOSTEMERGENCYSANITATIONRESPONSEANDORIFENTERINGTHESECOND PHASEWHENFACILITIESAREUPGRADEDANDTHERATIOOFPEOPLETOTOILETS DECREASESBAGSMAYSTILLBEUTILIZEDINHOMETOSUPPLEMENTGAPSIN Waterlines Vol. 30 No. 1 EXCRETA DISPOSAL IN EMERGENCIES: HAITI 77 ADEQUATE SANITATION COVERAGE WOMEN AT NIGHT CHILDREN OR PEOPLE WITHADISABILITY References &ENNER2'UTHERIE0AND0IANO%@0ROCESSSELECTIONFORSANITATION SYSTEMSANDWASTEWATERTREATMENTINREFUGEECAMPSDURINGDISASTERRELIEFSITU ATIONSWater and Environment Journal 'LOBAL 7!3( #LUSTER Lessons learned in WASH Response during Urban Flood Emergencies7%$#,OUGHBOROUGH5NIVERSITY5+ 'OVERNMENT OF (AITI Haiti Earthquake Post Disaster Needs Assessment, 'OVERNMENTOF(AITI )NTERNATIONAL&EDERATIONOF2ED#ROSSAND2ED#RESCENT3OCIETIES)&2# From Sustaining Lives to Sustainable Solutions: The Challenge of Sanitation in Haiti, )&2#'ENEVA -UENCH % 0ATEL $ AND 7IRSEEN # @0EEPOO ! NEW SUSTAINABLE SANITATIONSYSTEMFORURBANINFORMALSETTLEMENTSIWA Development Congress, -EXICO$&n.OVEMBER /XFAM'"WASH Research and Development Strategy/XFAM'"/XFORD 5+ 4HE 3PHERE 0ROJECT Humanitarian Charter and Minimum Standards in Disaster Response/XFAM'"/XFORD 5.$0Human Development Report. Beyond Scarcity: Power, Poverty and the Global Water Crisis5.$0.EW9ORK 5./#(!@+EY&ACTSAND&IGURESINTERNALDOCUMENT5./#(!.EW 9ORK 7(/5.)#%& Joint Monitoring Programme for Water Supply and Sanitation, Estimates for the use of Improved Sanitation Facilities: Haiti 7(/ 'ENEVA5.)#%&.EW9ORK Waterlines Vol. 30 No. 1 January 2011
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