Category Archives: NTDs

Eight Million Toilets and Counting

By Alice Carter

world toilet day 2015Normally, we don’t like to talk about bathrooms. That is a private space that most of us would largely like to avoid thinking about. But on World Toilet Day, we give thanks for our sanitary facilities and celebrate the invention of the toilet, which has saved countless lives as a disease control mechanism, and gives us privacy to, you know, go.

There is a Sesame Street song, a global “urgent run,” and an art show in New York. All of these types of events are celebrations for the often overlooked efficiency of the mundane technology that is a toilet, but also are opportunities to spread awareness of just how precious our access to toilets really is. One in three people around the globe don’t have access to adequate sanitary infrastructure, leaving them at increased risk for neglected tropical diseases (NTDs) that are spread through contact with fecally-contaminated soil. Half of the people who practice open defecation globally live in India, where 1.1 million liters of human excrement enter the Ganges River every minute. Recognizing the toll that open defecation takes on health, education and economic output, the government of India is trying to increase access to sanitation infrastructure and put an end to open defecation.

Prime Minister Modi has pledged that India will be open defecation free by 2019, and under his leadership the government has set up incentives for toilet construction and usage. Swachh Bharat Abhiyan — the Clean India Mission — is a sanitation campaign run by the Indian government, with the joint objectives of reducing open defecation and changing behavior to increase the use of sanitary facilities. Prime Minister Modi launched Swachh Bharat on Mahatma Gandhi’s birthday in 2014. The government also plans to raise Rs 3,800 crore (approximately 550 million USD) from the public to support this initiative, which gives subsidies for toilet construction and helps villages become certified as open defecation free. As of August 2015, 8 million toilets have been constructed as part of the campaign.

Unfortunately, it is tricky to measure the prevalence of open defecation and people’s toilet usage. Simply constructing a toilet in every home and school won’t make people start exclusively using toilets, especially if they don’t know the benefits of sanitation infrastructure and the risks of open defecation. For this, public awareness campaigns are also needed, and people need to be given plenty of reasons to use the toilet exclusively. One motivating factor for people to switch from open defecation to toilet use is awareness of the health risks of open defecation.

In communities that continue to practice open defecation, children playing outside or walking to school with no shoes can be exposed to contaminated soil, putting them at risk for infection by soil-transmitted helminths (STH). Similarly, clean drinking water sources and uncooked fruits and vegetables can be contaminated, increasing the risk of infection.

On the other hand, access to a household latrine has been found to reduce the risk of infection with STH by 40%. Nadia, a district in West Bengal, India, was the first district to be certified as open defecation free, and has since noted a decreased incidence of diarrhea and malnutrition. Reduced NTD infection is a strong indicator of the success of the Swachh Bharat campaign. Including an NTD indicator in Swachh Bharat would give the mission concrete targets to measure exclusive toilet use in communities where the campaign has built toilets, and it would help spread awareness of the negative health impacts of open defecation.

Perhaps on Gandhi’s 150th birthday, in 2019, India will have achieved its goal of ending open defecation. He would be proud, as he often stressed that a society’s approach to private and public sanitation reflects its commitment to true freedom and dignity.


Untouched: How 284 Liberian Communities Remained Ebola-Free

By Piet deVries, Senior WASH Advisor, Global Communities


A community hand washing station in Liberia. Credit: Global Communities

Everything changed with Ebola.

For four years, Global Communities had been busy creating access to safe sanitation for communities in Liberia, helping to fight the spread of disease and improve health outcomes. Utilizing Community-Led Total Sanitation, we were making consistent progress, beginning work through the USAID-funded Improved Water, Sanitation and Hygiene (IWASH) program in 2010 in the three Liberian counties of Nimba, Lofa and Bong. Our program gained the support of the national government, and we worked with them to develop their sanitation strategy to improve the health of rural communities across the country. By early 2014, we had helped 284 communities become “open defecation-free” and were working with more communities.

Suddenly we and our partners in the Liberian County Health Teams and the Ministry of Health found ourselves at the center of a maelstrom. To combat Ebola, we scaled up our community engagement work, training community leaders who were already working to prevent open-defecation in how to provide information about Ebola prevention. As the epidemic swelled, our community engagement approach shifted again, focusing on acceptance of vital services like dead body management, and eventually, health screenings. In just a few months, our work scaled up from three to all 15 Liberian counties.

It was during this time that we received reports of an astonishing statistic. All 284 open defecation-free communities were reporting that they were also Ebola-free — despite being located in some of the regions hardest hit by the virus.

Was there a link between being open defecation-free and Ebola-free? Or between our program’s process and Ebola resistance?

Earlier this year, we employed two independent public health consultants to conduct research into the informal reports we had received. They came back with extraordinary findings. Focusing their research on 551 households in Lofa County, they established with a representative sample that the communities that had reached open defecation-free status were indeed Ebola-free.

They also found that communities that had only started the Community-Led Total Sanitation process — but not reached full open defecation-free status — were 17 times less likely to experience a single case of Ebola. This suggests a statistically significant correlation between our work to become open defecation-free and being Ebola-free.

Still, it would be wrong to assume that these findings mean that simply becoming open defecation-free stops Ebola. Rather, they suggest that people who had been exposed to the program’s education were far more likely to develop healthier behaviors and practices that lead to Ebola resistance — especially when led by a member of their own community.

Perhaps most encouraging, these behavior changes don’t just defend against Ebola. By utilizing CLTS, individuals can help prevent a variety of water, insect-borne and diarrheal diseases, including many neglected tropical diseases. In addition, such methods are inexpensive; in Liberia, incentives of only $130 per community can result in far better sanitation practices. Make household latrines, hand washing facilities, garbage pits and dish racks available, and you have a safe, hygienic and resilient community.

Disease spreads at the community level, and only by engaging with the community to create sustainable change can we hope to control and eliminate many of the diseases that are so prevalent in the developing world. CLTS does just that, and any focus on water and sanitation must recognize the importance of empowering communities to make wise decisions to help improve their health.

END7 Students Are Gearing Up for a Record-Breaking #GivingTuesday

Giving Tuesday banner_1We have a day for giving thanks. We have two for getting deals. Now we have Giving Tuesday, a global day dedicated to giving back, celebrated each year on the Tuesday after Thanksgiving in the United States (December 1 this year). Giving Tuesday was launched in 2012 by 92nd Street Y, a cultural center in New York City, to celebrate and encourage giving. Now in its fourth year, Giving Tuesday is a global celebration of giving, fueled by the power of social media and collaboration. In 2014, over 27,000 nonprofits in 68 countries participated in Giving Tuesday, raising over $46 million for social causes. Beyond dollars and cents, Giving Tuesday has become a social media phenomenon: in 2014, the hashtag #GivingTuesday was used 764,000 times and trended for 11 hours on Twitter, raising awareness of social causes.

Giving Tuesday collageIn 2014, END7 launched a Giving Tuesday student fundraising competition, netting $10,154 from 22 participating schools — enough to treat 20,000 children for seven NTDs. This year, as our student community has grown around the world, we’re setting our sights even higher, with a goal of raising $20,000 from dozens of schools worldwide. You can see the list of schools who have signed on to participate on our Giving Tuesday page, where you can choose a fundraising campaign to support on December 1.

To reach this ambitious goal, END7 students around the world will hold bake sales, email friends and family, post all over social media, and rally their classmates to support the fight against NTDs. The timing of this effort is ideal as END7 supporters reflect on all of the progress made in the fight against NTDs in 2015. In the past three months, the United Nations endorsed a goal to end the epidemic of NTDs as part of the Sustainable Development Goals (and moved forward with the inclusion of an indicator to measure progress), Mexico announced their official elimination of the NTD river blindness, and the Nobel Prize in Medicine was jointly awarded to scientists who developed drugs that have saved millions of lives from NTDs and malaria.

And while these milestones deserve to be celebrated, END7 student supporters know that we can’t rest while less than half of people needing NTD treatment are receiving it because of persistent funding gaps for NTD programs. The END7 campaign was launched as a way to give everyone a chance to contribute to the effort to end NTDs, with 100% of donations to our campaign used to support NTD treatment programs.

giving tuesday unselfieIf you are a student, teacher or university administrator who would like to join in our Giving Tuesday effort, sign up to fundraise on December 1 with an event or online fundraising page. Be sure to check out our resources: the Giving Tuesday action kit, a short webinar with fundraising tips and tricks from student leaders, and a Facebook album with inspiring images to share or set as your profile or cover photo. To spread the word, sign up for our Thunderclap or send us an END7 #unselfie (unselfish selfie!) with a sign explaining why you support END7 —we’ll post the best ones on Facebook!

We hope to have students around the world doing their part to fill the NTD funding gap on Giving Tuesday. If that goal isn’t motivation enough, we’ll be awarding fun prizes to the school with the highest fundraising total, the school that with the highest number of donors, and the school with the most creative promotion (time to snap those #unselfies!). Sign up to participate today!

Inside the NTD Bubble: My Experience at the ASTMH Annual Meeting

By Jessica Ellis

Earlier this month I had was given the incredible opportunity to travel to Philadelphia to attend the American Society of Tropical Medicine and Hygiene (ASTMH) annual conference with the support of a scholarship from the END7 campaign. The conference consisted mostly of symposia and scientific sessions led by international panels of physicians, CEOs, WHO representatives, and other global health experts. During these sessions, while frantically figuring out how to simultaneously listen, take notes, live-tweet and keep track of acronyms to look up later, I was introduced to the vast scope of the global health community.


Jessica Ellis and Emily Conron, END7 student coordinator, at the ASTMH 64th Annual Meeting.

A significant focus of the symposia was the quantification and logistics behind the process of tracking and verifying the elimination of NTDs. So often in my END7 advocacy experience, we have joyfully announced elimination of a disease in a certain country, but learning about the human efforts and data collection behind disease elimination has changed the way I will treat these declarations. In the first session of Monday morning, a WHO representative gave a briefing about the TAS (Transmission Assessment Survey) that determines when to cease Mass Drug Administrations (MDAs), and I frantically copied down the phrase into my notes. By the second day of ASTMH, I found myself discussing the efficacy and possible alternatives to the TAS system for various west African nations. My total immersion into these passionate, professional discussions of global health policy and practice inspired me to absorb every detail that I could. It was immensely satisfying to realize how much more I could now contribute to my work with END7 on campus armed with my newfound knowledge.

Aside from international policies and paperwork, the more nuanced talks about MDA implementation in different countries, or even different villages, revealed to me another dimension of the NTD control and elimination effort. I learned about the independently financed elimination efforts in Malawi, and the effects of Ebola upon MDAs in Sierra Leone. It was fascinating to hear representatives of NTD programs in West African countries initiate a passionate discussion about the effects of neighboring countries’ disease rates upon those who are close to elimination. These conversations were both heavily researched and fueled by intense national pride from countries nearing NTD elimination.

astmh The Ebola epidemic was not merely a bullet point at ASTMH. In the lobby of the conference center, a replica Ebola Treatment Unit was set up, which allowed visitors to experience the working conditions of Ebola centers. We were shown how to put on the iconic hazmat suits and personal protective equipment, given several tasks typical of a physician’s two-hour shift, and then spent over thirty minutes being taught how to remove the suit. Removing, or “doffing,” the equipment was an amazingly arduous, stressful regimen even in our completely sanitary, air-conditioned space. The stories told by those who had worked the treatment units  on hand at the replica unit to share their perspective  described understaffed days, inconsistent and inadequate equipment, tropical temperatures, and the constant threat of infection if any part of this procedure was neglected. The men and women who served in these conditions displayed a level of ingenuity and stoicism normally associated with war heroes, and I left greatly humbled and inspired.

There was one session in particular that equipped me for future END7 student advocacy. Two women who bluntly identified themselves as non-scientists led a session entitled “How to Talk about Money When All You Care About is Saving Lives.” Jodie Curtis, an executive at a D.C. lobbying firm that represents ASTMH, spoke first about the numbers that make up the current global and national foreign aid budget. She revealed which nations and which US sectors spend the most on global health, and which health issues receive the most money. The end of her talk detailed “6 Things to Know” about government funding; the theme of which was how to communicate to government officials about a technical or nuanced topic.

This session provided not only quantitative data about government funding that I could share with students, but also recommendations for how to discuss a niche subject such as NTD elimination, which is very applicable to campus advocacy. The catchphrase of the hour was “tell you story, not your data.” This idea of going light on the epidemiology and statistics behind NTDs with a general audience, focusing instead on telling a broader story they can understand and relate to, can be used to reach a student audience on an emotional level. Case studies of the impact of an MDA, or personal anecdotes about a child who recovered from a worm disease and could now attend school, resonate with everybody in a way that statistics sometimes cannot.

Excited by my newly acquired knowledge of TAS and various R&D discoveries, I left the “NTD bubble” I had been immersed in for three days excited to communicate this information to others. In the coming month, I am giving a talk at an event hosted by UT student organization “Advocates for Awareness.” In addition to introductory NTD information, I hope to use my experience at ASTMH to discuss recent developments in global policy support of NTDs, instilling the sense of urgency and excitement around this cause that I took away from my time with the powerful global health community that I met in Philadelphia.

Jessica Ellis is a sophomore at the University of Texas at Austin majoring in biology. She is the president of END7 at UT and is serving on the END7 Student Advisory Board for the 2015-2016 academic year.